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Participant-Directed Waiver Services

People enrolled in a Individual Options, Level One, or Self-Empowered Life (SELF) waiver can choose to direct one or all of their Homemaker/Personal Care (HPC) services by choosing Participant-Directed HPC.

Directing a waiver service means either acting as an employer or directing the budget for at least one service.

  • Participant-direction is an option for Homemaker/Personal Care services for people enrolled in an IO or Level One waiver.
  • Participant-direction is a requirement of the SELF Waiver. It is available for Homemaker/Personal Care and other services. A person enrolled in the SELF Waiver must be willing and able to direct at least one service, or chose a representative to direct at least one service on their behalf.

Support for Participant-Direction

Waiver participants under the age of 18 can have their parents help direct their services. Adults choosing participant-direction 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 staff will be paid,
  • providing training to employees,
  • making sure employees are providing services in the plan,
  • helping to communicate choices and preferences to employees,
  • signing timesheets,
  • and keeping required paperwork or records.

County board of developmental disabilities staff can help waiver participants to direct their services. Service and support administrators, or SSAs, can help participants to direct services while following rules that apply to their waiver.

If you choose to direct your services, you may need to learn new skills, including things like supervising workers, keeping track of funding limits, and budgeting. 

Your SSA or a support broker can help you develop or strengthen your skills. Your SSA will help make sure you can recruit, hire, train, supervise, and fire your support staff, create a budget for the services you need, and reach an agreement for rates for your staff.

Financial management services are also available to support people directing one or more of their services, providing support for people acting as an employer or directing the budget for one or more of their waiver services.

Financial management services are paid through a contract with DODD, not with funds from your waiver budget.

Employer and Budget Authority

Employer Authority

Employer Authority means directing a waiver service by acting as the employer or co-employer for staff that provides your services.

You can choose how much responsibility you want to take on as the employer. You can take on all of the responsibility and recruit, hire, train, and supervise service providers as your employees.

You can choose to be a co-employer and manage the day-to-day tasks of your staff while working another person or an agency that will manage things like taxes, paychecks and timesheets for your staff.

When used with employer authority, financial management services can complete all new employee paperwork, receive and process timesheets, issue paychecks to your employees and withhold all required taxes and workers’ compensation premiums.

Budget Authority

Deciding which services you use and the amount from your waiver budget that you spend on each service is known as Budget Authority. In some cases, you can negotiate the rate you pay your service providers.  The amount paid must be within Medicaid guidelines and cannot go beyond waiver funding limits.

When used with budget authority, financial management services help budget, track spending, and pay for items and services. It can also provide monthly reports to you and your SSA to help you keep track of your waiver budget.

Services with Employer or Budget Authority 

 

 

Name of Service

Budget Authority

Employer Authority

Ability to Negotiate Rates

Adult Day Support

Career Planning

Clinical/Therapeutic Intervention

Community Respite and Residential Respite

Functional Behavioral Assessment

Group Employment Support

Individual Employment Support

Non-Medical Transportation

On-Site On-Call

Participant-Directed Homemaker/Personal Care

Participant-Directed Goods and Services

Participant/Family Stability Assistance

Remote Support

Support Brokerage

Transportation

Vocational Habilitation

Leaving Participant-Direction

Waiver participants can choose to end participant-direction at any time. Since participant-direction is a requirement for the SELF waiver,  the type of waiver you are enrolled in may be affected.  IO or Level One waiver enrollees will only need to choose a different service.

Participant-direction can also be involuntarily terminated if the participant's health and welfare cannot be ensured. An SSA must issue due process upon termination of participant-direction and assist you with selecting and transitioning to traditional services.