States that allow disabled Medicaid beneficiaries to direct their own personal care services should be careful to provide sufficient support to help beneficiaries find quality direct care workers and back-up assistance when needed, according to two new reports from the Kaiser Commission on Medicaid and the Uninsured. In 2006, 42 states offered programs allowing Medicaid beneficiaries to direct their own personal assistance services. Based on a study of programs in California, Colorado, New York and Virginia, the commission said beneficiaries highly value the ability to choose their own direct care workers and set their own schedules, but that some may need more support than the consumer-directed model has to offer. Beneficiaries who choose to continue using an agency-directed program cited the need for reliable back-up assistance as the primary reason.