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April News & Updates
Independence & Empowerment
What does “Self-Directing” mean?
Self-directing emphasizes independence and empowerment by expanding your degree of choice and control over your long term services and supports. It allows you and your authorized representative to serve as the employer and take responsibility for directly hiring, training, supervising, and firing your paid workers. You and your authorized representative become the experts on your own care and are able to determine the services and supports that best meet your personal care needs.
Control, Flexibility & Freedom
Are you utilizing your MCO (Managed Care Organization) benefits to access the PPP/PCA program?
The New Jersey Personal Preference Program (PPP) offers an alternative way for NJ FamilyCare Plan A members to receive their Medicaid Personal Care Assistant (PCA) services without the use of a home health care agency. The PPP allows elderly and disabled Medicaid recipients to self-direct and manage their PCA services. The PPP offers you greater control, flexibility, and freedom. You can choose who provides your care, what type of care you want and need, when you want care to be provided and where the care will be provided. Workers become accountable to you/authorized representative. In self-directed programs, you negotiate PCA wage rates within the program rules, purchase other goods and services to increase safety and independence in the home or reduce your need for paid services. You may also choose to take 10% of the monthly budget as cash for justifiable purchases of goods and services not readily available through other means.
How does PPP differ from the PCA Program?
The PPP differs from the PCA program in that it allows for more consumer control, flexibility, and direction. Instead of relying on an agency to provide the services, the PPP allows you to hire your own worker to handle your needs. The PPP requires you to become an employer, which requires additional responsibilities. You will now be the employer of record. The PCA program uses a provider agency to fill your hours.
Did you know that you can hire your own employee through the budget?
Self-Directed Services is an approach to the delivery of home and community based services that offers increased control and choice over how and from whom you receive support. The Self-Directed Employee (SDE) option for self-directing services enables you (or your guardian) to recruit, hire and manage employees to provide prior authorized direct support services. This can be done through your MCO budget! The NJ Department of Human Services offers two SDE models for individuals who choose to self-direct their services: Vendor Fiscal/Employer Agent (VF/EA) and Agency with Choice (AWC). Individuals choosing to participate in either of these SDE models should review NJ Department of Labor and Workforce Development labor laws to ensure that, in their role as employer of record or co-employer, they are abiding by those laws (e.g., ensuring employees are not discriminated against). The fiscal intermediary for the SDE model selected can help answer questions related to your role and responsibilities within that model.
Can you utilize the PPP/PCA program AND have an SDE in the Fee-For-Service waiver?
Yes you can! While the Employer of Record cannot be the same, utilizing the PPP/PCA program and having an SDE through Fee-For-Service is permitted. 
Exploring the Monthly Budget
What Can I purchase with my monthly budget?
• Employment of individuals, including family members, to provide personal assistance; • Cleaning services from private companies to clean personal areas including bedroom, bathroom, kitchen, etc.; • Errand service to assist with banking, shopping and other types of routine tasks; • Laundry service from a laundromat or other provider; and, • Supplies and equipment that promote or enhance independence that are not covered by Medicaid.

How is the monthly budget determined?
Your MCO (Aetna, Amerigroup, Horizon NJ Health, UnitedHealthcare Community Plan or WellCare) is responsible for authorizing the number of Medicaid PCA hours you are eligible to receive, to provide you with options counseling and to enroll you into the PPP. The MCO uses the hours of service authorized from your initial PCA clinical assessment (or most recent reassessment) as the basis for determining your monthly budget. The number of authorized hours is converted into a dollar amount using the current reimbursement rate. A standard administrative deduction is then calculated to cover the costs of counseling and bookkeeping services. The remaining amount is available to you for purchasing services. The financial consultant will assist you in developing a cash management plan to help determine how best to spend your monthly budget to purchase services that you need.

What should I do if I’m not taking advantage of the PPP/PCA program through my MCO?
CONTACT YOUR SUPPORT COORDINATOR AT SPECTRUM CARE MANAGEMENT AND COUNSELING AND WE WILL GUIDE YOU!

Contact Spectrum CMC
65 Ramapo Valley Road, Mahwah, NJ 07430