Date of Award


Degree Name



College of Liberal Arts

Type of Degree


Document Type


First Advisor

Richard Garnett

Second Advisor

Kenneth Ambrose

Third Advisor

Gary Jarrett


Medicaid-funded long-term care services are traditionally delivered in nursing homes. States may apply for waivers which allow them to provide home and community based services with Medicaid funds. Because these services are by definition an alternative to nursing home care, waiver services are generally based upon a medical model which emphasizes medical deficits and tends to restrict consumers’ movements to inside the home. Recent developments such as the Olmstead Decision and federal New Freedom Initiatives have caused states to recognize that consumers desire and have a legal right to be part of a community rather than institutionalized or homebound. These developments are forcing states to look for new ways to bring Medicaid services to consumers. One such model of service delivery is consumer directed services. The two key concepts of consumer directed services are 1) Individual budgeting: A pre-determined amount of Medicaid money set aside monthly through a fiscal intermediary that the consumer can use to purchase goods and services; 2) Consumer direction: The consumer is the employee of record for service providers and hires providers including friends, neighbors and family members or can contract for services through an agency. The consumer hires, trains, schedules, supervises and dismisses his or her providers. West Virginia is one of only five states chosen to participate in a project funded by the Robert Wood Johnson Foundation and administered by the National Association of State Units on Aging (NASUA). The West Virginia Bureau of Senior Services (BoSS) is the agency representing the state in this endeavor called “Expanding Consumer Direction in Aging Services”. BoSS is the agency that administers the Medicaid Aged and Disabled Waiver program in West Virginia and that population is targeted in the program. Recipients of the A/D waiver are adults (19-64) who have a disability and elders (65 or older) who meet the medical criteria. This work documents the agency’s efforts over nineteen months to expand opportunities for participants in the A/D Waiver to exercise more control over the services they receive.



Poor aged - Medical care.

Old age assistance.

Poor aged- Services for.

People with disabilities - Services for.

People with disabilities - Medical care.