Medicaid beneficiaries who need help living at home could soon choose to receive a cash allowance to hire their own home care workers or even pay a family member to deliver their care.

Currently Medicaid beneficiaries who need help with activities of daily living like bathing and dressing must work with personnel employed by a home-care agency. But beneficiaries often have limited choices about how and when their care is provided, especially since agencies generally do not provide care on weekends or outside normal business hours.

Now, the Centers for Medicare & Medicaid Services (CMS) has proposed a new rule that would give beneficiaries a cash allowance to hire, direct, train or fire their own personal care workers to help with things like preparing meals, household chores and other related services that help a person to live independently. Beneficiaries could even hire qualified family members who may already be familiar with the individual’s needs to perform personal assistance (although not medical) services.

In addition, the allowance could be used for assistive technologies or home modifications that could reduce dependency on human assistance, such as a wheelchair ramp or microwave oven. The beneficiaries also have the option to have their cash benefit allotment managed for them.

“This proposal would give Medicaid beneficiaries significant new freedom to determine how their personal assistance services are delivered and by whom,” said Kerry Weems, CMS acting administrator. “As health care is not simply an economic transaction, this proposal represents a fundamental shift that restores a person’s ability to improve their overall health by taking greater control of his or her own decisions.”

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