Power shifts and Conflicts of Interest

This document dives into Wisconsin’s Robert Wood Johnson Self-Determination Project, exploring how self-determination can empower people with developmental disabilities to take control of their services and supports. ​ It highlights the shift from traditional, county-controlled systems to a more flexible, participant-driven approach using Medicaid’s HCBS waiver. ​ Key themes include anticipated power shifts, cultural challenges, and the role of guardians in decision-making. The project aims to give individuals more say in how public funds are spent, fostering personalized services and greater independence. ​ However, it also addresses practical concerns like provider resistance, transaction costs, and the balance between choice and accountability.

Readers will learn about the complexities of implementing self-determination, including the cultural changes needed to truly empower participants. ​ The document emphasizes the importance of collaboration, principled negotiation, and bold leadership to overcome systemic barriers. ​ It also explores the ethical dilemmas and safeguards required to ensure quality services while respecting individual choices. ​ Whether you’re a policymaker, advocate, or curious reader, this document offers valuable insights into transforming service systems to prioritize dignity, choice, and community inclusion for people with developmental disabilities.