Some promising news....perhaps this can be adapted to give individuals with psychiatric disabilities the chance to get peer personal care assistance services ....

HHS Approves Colorado Medicaid Demonstration to Give Home-Bound Patients Greater Control of Their Care 
August 8, 2001 

WASHINGTON, Aug. 8 /U.S. Newswire/ -- HHS Secretary Tommy G. Thompson today approved a new Medicaid demonstration program in Colorado that will give elderly or disabled individuals who qualify for Medicaid the opportunity to control and manage their personal care and skilled nursing services. 

The 150 Medicaid beneficiaries who enroll in Colorado's demonstration program will be able to determine the types of home care services, and the providers of those services (including family members), that best meet their individual needs. 

"Colorado's pilot program represents an innovative way to give consumers more control of their health care and their lives," Secretary Thompson said. "In his New Freedom Initiative, the President laid out a comprehensive plan to open the doors to independence to Americans with disabilities. Colorado's creative approach provides needed flexibility to help elderly and disabled people participate more fully in community life." 

The pilot program will provide funds that would have otherwise been paid to home health agencies directly to the disabled or elderly individuals who are able to direct their own care. These individuals will be able to recruit and hire caregivers to provide personal and skilled care services, and at times that are most convenient to them, such as evenings or weekends. In an effort to expand the program and provide additional flexibility, the state has amended its Nurse Practice Act to allow for these improvements. 

Program enrollees will also be able to accumulate savings which, with prior authorization, may be used to purchase goods and services that will support additional health care needs such as specific adaptive aids and communication devices. 

The Colorado program is one of a number of state Medicaid waivers that are designed to extend and improve health care coverage to eligible residents. These projects, including the Colorado program, must be budget neutral, meaning that states would have access to the same amount of federal funding under the demonstration that they would have received under current law.