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Understanding Self-Direction: How It Benefits You or Your Loved One

How and why self-directed support can be the right choice for you or your loved one

Self-directed care is a powerful choice that lets you or your loved one maintain control over your care. With self-direction, you have the freedom to live in your home and community and decide who delivers your care, such as friends or approved family members. This is opposed to institutionalized care or having an agency send possibly different personnel every week.

Together with your case manager (who may be called counsellor, support broker, service/care coordinator instead), you determine how best to use your approved budget to ensure you get the support and services you need.

A Financial Management Services (FMS) provider or Fiscal Intermediary, like Public Partnerships, is appointed to help you manage your support and services, all within your approved Medicaid budget.

When deciding if self-direction is right for you or your loved one, it’s important to know that self-direction gives you control and freedom with:

  • Support: help with daily living such as bathing, medical care, cooking, cleaning, etc.
  • Services: funds to support personalized needs such as transportation, home modifications, physical therapy, community classes, skills training, etc.

(Note: Every self-direction program has a list of approved care services. Please check your program guidelines to confirm the support and services available to you.)

These services are not always provided in agency care or institutionalized care.

In this blog we answer the common questions we hear about self-direction. It’s our goal to give you the information you need to make an informed choice about your or your loved one’s needs.

What is Self-Direction?

Self-direction is a service model that empowers participants, usually eligible for Medicaid, such as yourself or your loved one with choice and control over the long-term services and supports you need to live at home. See this video explanation!

Self-direction may also be called consumer direction, participant direction, or self-determination.

Self-direction typically means you or your representative hire someone you know and trust to provide you with the services and support you need to remain in your home and community. This process means that you (or your representative) are responsible for employing and paying the person who takes care of you, usually with Medicaid or state funds. We have more information on how to enroll in Self-Direction in our Enrollment Blog or you can contact us!

For example, you may want to hire your friend to come help you around the house and transport you to your doctor’s appointments. This way you get the personalized help you need, and your friend is compensated for their time!

In agency and institutionalized care, you usually don’t get to choose who supports you and there may be a different stranger coming to you each time, where you have to reexplain what you need to a new person again. Self-Direction helps keep you at home and supports you in your community by offering these services!

“Self-direction promotes personal choice and control over the delivery of waiver and state plan services, including who provides the services and how services are provided. For example, participants are afforded the decision-making authority to recruit, hire, train and supervise the individuals who furnish their services.” (Self-Directed Services,

10 Benefits of Self-Directed Care

How Does Self-Directed Care Work?

Federal and state regulations require that key programs and supports be in place to ensure that self-directed care works as mandated:

  • Person-Centered Planning: you specify the support and services you need to be healthy and live a full life.
  • Individualized Service Plan (ISP): your case manager may help you create an ISP that ensures you have the care, support, and services you need to live in your home and community. This plan specifies what you need from your care/support worker, how this fits within your individualized budget, and what you will do in the event your care/support worker is unavailable.
  • Support Systems: the federal government requires your state to have systems of support in place that ensure that you receive your self-directed care. These support systems include assistance with developing your ISP, budget advice, resources/training that can help you experience self-direction success, and advice on using an FMS for payroll.
  • Financial Management Services (FMS): an FMS provider helps you manage your support and services. This includes helping with employee enrollment and background checks, paying your care/support workers and service vendors on your behalf, budget management and timesheet approval.

What is the Role of an FMS Provider in Self-Directed Care?

An FMS or Financial Management Services provider has a critical role in the success of self-directed care for you or your loved one. As Medicaid laws in most states can prohibit direct cash payments to individual self-directing program participants or their representatives, states or managed care organizations appoint an FMS provider company to assist.

The role of an FMS in self-directed care includes:

  • Helping you prepare for your role as an employer of care/support workers.
  • Assistance with completing federal and state required enrollment forms and completing background checks.
  • Payment of your care/support workers’ payroll taxes on your behalf.
  • Payment of your service vendors on your behalf.
  • Assistance with budget management and approval of your care/support workers’ time sheets.

We are committed to our mission to transform more lives by making self-directed home care easier for all. The Public Partnerships team is always available and accessible to help you with any questions and concerns you have about self-direction. Contact us by chat or phone here!