Participant Self Direction

The ability to direct and manage their own services and supports is important to many individuals who need the home- and community-based services (HCBS) provided through state Medicaid programs. These self-directed models may also be known as "consumer direction" and "participant direction" when referring to specific states' programs. In these models, individuals direct many or all of their own HCBS, including selecting and managing direct service workers and/or managing a budget (known in some states as a service cost maximum) for needed services.

This tip sheet offers suggestions for states operating managed long-term services and supports programs or other managed integrated care programs to: (1) understand the person-centered planning process; (2) establish robust contract requirements and policy guidance that support person-centered self-direction models; and (3) assess managed care plans’ person-centered planning practices in self-directed models.

This tool gives examples of the roles and responsibilities of the individual, representative, case manager, information and assistance function, the financial management services function, and the direct care worker.

This document describes the purpose and qualifications of representatives.

This resource suggests topics to be covered in a policies and procedures manual for the day-to-day management of the self-direction program. Programs should add topics as needed to ensure efficient and consistent program operations.

This document offers the Centers for Medicare & Medicaid Services' (CMS) guidelines for permissible goods and services, and can be customized to include additional state guidelines.

This document reviews the individual's rights under the self-directed option as well as his or her associated responsibilities for participation.

This document answers common questions about self-direction including: (1) what is self-direction and why is it an important option for individuals receiving HCBS; (2) what are the components of self-direction. The document also defines self-direction terminology. It is intended to be used by case managers and other involved in self direction implementation.