Person-centered planning is an approach to planning and coordinating services and supports based on an individual’s goals, needs, preferences, and values.1,2 While the planning process is facilitated, the person is at the center and directs the development of the plan. The goal of person-centered planning is to create a plan that optimizes the person’s self-defined quality of life, choice and control, and self-determination through meaningful exploration and discovery.1 The process typically involves assessment and planning that is based on the preferences of the individual and includes family, friends, and others that the individuals chooses to be involved.1

Origins of person-centered planning date back many decades, particularly within the intellectual and developmental disabilities (IDD) service system.3 Although similar philosophical underpinnings have emerged in service systems for other populations receiving HCBS, including older adults and individuals with dementia.4 Many different definitions of person-centered planning exist, consensus has been challenging, and there are ongoing debates about best approaches, terminology, and key aspects of the process.5

Over the last decade, the Administration for Community Living (ACL) and the Centers for Medicaid and Medicare Services (CMS) have worked to promote greater clarity and consistency to advance person-centered planning broadly within Home and Community-Based Services (HCBS) programs. In 2014, CMS issued regulations requiring aspects of the person-centered planning process and components of the service plan for individuals receiving Medicaid HCBS.6 The US Department of Health and Human Services (HHS) has further extended these requirements to other federally funded programs beyond Medicaid.7 Given the lack of a national quality measure for person-centered planning, and the lack of evidence-based strategies to inform such a measure, ACL and CMS also supported a multi-stakeholder National Quality Forum (NQF) Committee on Person-Centered Planning and Practice that sought to develop a common definition, identified core competencies of individuals facilitating person-centered planning, and developed an initial framework for measuring person-centered planning.1 Building on this work, ACL and CMS has supported the National Center on Advancing Person-Centered Practices and Systems (NCAPPS) to provide technical assistance to assist states and systems in implementing person-centered planning.

Studies on the extent to which person-centered planning is being implemented and evidence of the impact on community living and health outcomes are limited. Few studies on outcomes exist and most are focused on individuals with IDD. Syntheses of the research literature8,9 found that the overall quality of evidence was low, but suggestive of positive outcomes, including increased choice and control, community participation, and improved relationships and social networks. Research has identified the importance of contextual factors on access to and efficacy of person-centered planning.10 Lack of agreement on a definition and conceptual measurement framework, best approaches to measurement, and availability of standardized measures have posed challenges to research.2 The NQF Committee on Person-Centered Planning and Practices suggested an initial measurement framework consisting of three domains: Person-Centered Plan (i.e. plan creation, content, person-reported measures), Facilitator (i.e. facilitator competencies, communication, plan content development), and System Level (i.e. structures, process, and outcomes related to training, resources, quality).1 However, additional work is needed to provide more specifics on potential measurement approaches within these domains.

We conducted an exploratory study to identify key aspects of the person-centered planning process from the perspectives of (1) Medicaid HCBS beneficiaries receiving person-centered planning and (2) individuals facilitating the person-centered planning process in three states (referred to as care managers within the context of this study). With the overarching purpose to inform potential approaches to measurement, our two primary research questions were:

What are facilitators of person-centered planning from the perspectives of individuals receiving HCBS and care managers?

What are barriers to person-centered planning from the perspectives of individuals receiving HCBS and care managers?