Over the past several years, a multitude of factors have converged to make the financing and delivery of personal assistant services (PAS) two of the most critical issues in American disability policy making. This article chronicles the development of assistive services and examines some of the more noteworthy strategies designed to improve PAS policy making. The argument is made that PAS should be a mandatory benefit provided through Medicaid. This approach, although imperfect, holds the greatest potential for improving the PAS delivery system. Incorporating PAS as a Medicaid benefit offers advantages over the current system, including the opportunity for ongoing need and satisfaction assessment among program beneficiaries, the development of a platform for strengthening the personal assistant workforce, and the ability to generate evidenced-based recommendations for improved service outcomes and cost-effectiveness.
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