Participant direction, Consumer direction, Home and community-based services, Affordable Care Act, Managed care
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In recent years, the provision of long-term care in the United States has continued its movement from what was once a predominantly institutionally based system of care to one in which recipients can increasingly receive a range of both medical and supportive services at home and in the community. As the availability of home and community-based services (HCBS) grows, so does interest in consumer- or participant-directed models of service delivery.

Participant direction is grounded in a philosophy of self-determination that seeks to maximize consumer autonomy and choice and ensures that persons with disabilities are empowered to live as independently as possible. In its purest form, participant direction shifts...

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