Recruiting, Selecting, and Retaining Direct Service Workers to Provide Self-Directed HCBS

What Programs Have Self-Directed Supports?

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There are different kinds of programs that offer self-direction.  Check with your service coordinator to make sure you know how your programs work.

Examples of programs available include:

Your state's agency that provides Medicaid waiver program-funded long-term services and supports may offer an option to self-direct your own supports. Every state designs its own Medicaid waiver programs. Check with your local agency about what options are available to you. If you are self-directing your own supports, the following apply to you:

  • States must have an assessment and planning process to develop a person-centered service plan. In this plan, you identify your preferences, needs, and desired outcomes. Your plan will also include a back-up plan in case your supports aren’t available.
  • Your person-centered service plan identifies the services and supports that can help you to meet your needs and that may help you direct those services and supports and remain in the community.
  • You will have a budget plan. This tells you the amount of funds that you control to purchase your supports. These are the funds you use to pay your DSWs. Your assessment and planning process determines what your budget is.
  • States are required to provide information and assistance to people who use self-directed supports. This assistance might include helping to develop your person-centered service plan and budget plan, direct your services, and manage your workers.
  • You might have a person-centered planner, service coordinator, supports broker, or some other person to help you.
  • Financial management services will assist you with payroll and other payments for your supports.

The Veteran Directed Care (VDC) program is for veterans who use personal care services paid for by the Department of Veterans Affairs (VA). Veterans using this program are given a budget for services. You are able to hire your own DSWs to provide your supports. The VA provides counselors to assist you with this program. Not all VA Medical Centers offer the VDC program.  Please visit the VDC page on the Administration for Community Living’s No Wrong Door website for more information and to determine if the VDC program is offered near you.  In this program you will:

  • Develop a care plan that outlines your services, supports, supplies, and estimated budget to help you live at home or in the community.
  • Submit your care plan for approval and receive a spending budget.
  • Hire and schedule all DSWs and buy necessary supplies approved in your budget.
  • Work with a financial management service to pay your DSWs and to pay for other approved services and supplies.