People enrolled in Individual Options (IO), Level One, or Self-Empowered Life Funding (SELF) waivers can choose to direct some of their waiver services. Participant-direction means the person using a waiver can make some decisions about the staff they hire or some of the services purchased with their waiver budget.

Participant-direction is a requirement of the SELF Waiver. A person enrolled in the SELF Waiver must be willing and able to direct at least one service, or they may choose a representative to direct at least one service on their behalf.

Support for Participant-Direction

Parents or guardians act as the representative and help direct services when a waiver participant is under the age of 18. Adults choosing participant-direction may direct their own services or they can have anyone they want act as their representative, including a friend, family member, or legal guardian.

This representative can help with things like

• finding and recruiting employees,
• scheduling and participating in interviews,
• negotiating the rate employees will be paid,
• training employees,
• ensuring employees provide the services authorized in the person’s plan,
• communicating choices and preferences to employees,
• signing timesheets,
• and keeping required paperwork or records.

A person’s Service and Support Administrator (SSA) can help by discussing participant-direction options, ensuring their chosen representative is identified in the Individual Service Plan (ISP), authorizing services, and monitoring implementation of the ISP.

People enrolled in a SELF waiver also have the option to choose a Support Broker to help direct their services. A Support Broker works with a person and their SSA to develop the Individual Service Plan and waiver budget. A Support Broker’s services are paid through the person’s waiver budget.

Financial Management Services (FMS) are available to support people who choose to direct one or more waiver services. Financial management services are paid through a contract with DODD, not with funds from a participant’s waiver budget.

Employer and Budget Authority

Employer Authority

Employer Authority means a person using a waiver acts as the employer or co-employer of the staff providing their services. With co-employment, an agency is the employer of record, but the person directs their staff each day.

As the employer or co-employer, a person hires, trains, schedules, supervises, signs timesheets, and dismisses their staff. In some cases, the person may decide how much to pay their staff. Staff cannot be paid less than minimum wage or more than the maximum amount Medicaid allows.

When used with employer authority, the FMS can complete all new employee paperwork, process timesheets, issue paychecks to employees, and withhold all required taxes and workers’ compensation premiums.

Budget Authority

Budget Authority means the person using a waiver helps decide how their waiver budget is spent. They can choose some of the services they receive and decide how much of the waiver budget to spend on those services. The person can negotiate the rate of pay for some services.  The amount paid must be within Medicaid guidelines and cannot go beyond waiver funding limits.

When used with budget authority, the FMS helps budget, track spending, and pay for items and services. The FMS can provide monthly reports to the participant and their SSA to help keep track of the waiver budget.

Services with Employer or Budget Authority 

Employer Authority can be used with these waiver services:

• Participant-directed homemaker/personal care
• Self-directed transportation
• Support brokerage

Budget Authority can be used with these waiver services:

• Clinical/therapeutic intervention
• Participant-directed goods and services
• Participant-directed homemaker/personal care
• Self-directed transportation
• Support brokerage

Rates can be negotiated for these waiver services:

• Clinical/Therapeutic Intervention
• Participant/family stability assistance
• Participant-directed homemaker/personal care
• Self-directed transportation
• Participant-directed goods and services

All services may not be available with every waiver.

Leaving Participant-Direction

Waiver participants can choose to end participant-direction at any time. Since participant-direction is a requirement for the SELF waiver, a person may need to enroll on a different waiver.  IO and Level One waiver participants will only need to choose a different service.

Participant-direction can also be involuntarily ended if the waiver participant's health and welfare cannot be ensured. An SSA must issue due process upon termination of participant-direction and help the participant select and transition to traditional services.