Consumer-directed care by state
The person receiving care (or their representative) hires, schedules and supervises their own aide, often a relative or friend; a fiscal intermediary handles payroll and taxes. Which states have it, the programs that provide it and whether a family member can be the paid caregiver.
- States with it
- 50 of 51
- Family can be paid
- 49 states
- Programs
- 75
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What consumer-directed care is
Consumer-directed care (also called self-directed or participant-directed care) puts the person receiving care in charge of their own aide. They, or a representative, recruit, hire, train, schedule and supervise the worker, and can replace them.
Because the participant is the legal employer, a fiscal intermediary or fiscal/employer agent runs payroll, withholds taxes and checks backgrounds. Some states use an agency-with-choice model instead, where an agency is the co-employer.
It is the main way family members are paid to care for a relative on Medicaid. States differ on which relatives may be hired: many allow adult children and other relatives but bar spouses and parents of minor children, while some allow them in limited cases.
Consumer-directed care: every compiled state
| State | Has it | Program | Family can be paid |
|---|---|---|---|
| Alabama | Yes | Personal Choices | Yes |
| Alaska | Yes | Community First Choice — Personal Care Services (CFC) | Yes |
| Arizona | Yes | Self-Directed Attendant Care (SDAC) | Yes |
| Arkansas | Yes | IndependentChoices | Yes |
| California | Yes | In-Home Supportive Services (IHSS); Self-Determination Program (SDP); Waiver Personal Care Services (WPCS) | Yes |
| Colorado | Yes | Consumer-Directed Attendant Support Services (CDASS); In-Home Support Services (IHSS) | Yes |
| Connecticut | Yes | Community First Choice (CFC); DDS Self-Directed Supports; Personal Care Assistance Waiver | Yes |
| Delaware | Yes | DSHP Plus Participant Direction (consumer-directed attendant care); Self-Directed Personal Care/Attendant Care for Children (SDAC) | Yes |
| District of Columbia | Yes | Services My Way (Participant-Directed Community Support Services) (PDCS) | Yes |
| Florida | Yes | Consumer-Directed Care Plus (CDC+); Participant Direction Option (PDO) | Yes |
| Georgia | Yes | Consumer-Directed Personal Support Services (CD-PSS) | Not stated |
| Hawaii | Yes | Self-direction option for QUEST Integration personal assistance and respite | Yes |
| Idaho | Yes | Adult Developmental Disabilities Waiver; Participant-directed A&D Waiver services through a Fiscal Intermediary (FI) | Yes |
| Illinois | Yes | Home Services Program (HSP) — Individual Provider / Personal Assistant (IP); Home-Based Support Services (HBS) — Adults with DD Waiver and Children's Support Waiver (PSW) | Yes |
| Indiana | Yes | Consumer-Directed / Participant-Directed Attendant Care (PDAC) | Yes |
| Iowa | Yes | Consumer Choices Option (CCO) | Yes |
| Kansas | Yes | Self-Directed Personal Care Services | Yes |
| Kentucky | Yes | Participant Directed Services (PDS) | Yes |
| Louisiana | Yes | Self-Direction | Yes |
| Maine | Yes | Consumer Directed Attendant Services (Section 12) (CDAS); Section 19 Participant-Directed Option (PDO) | Yes |
| Maryland | Yes | Self-Directed Services Delivery Model (DDA) | Yes |
| Massachusetts | Yes | MassHealth Personal Care Attendant Program | Yes |
| Michigan | Yes | Home Help Program | Yes |
| Minnesota | Yes | Community First Services and Supports — budget model; Consumer Directed Community Supports (CDCS) | Yes |
| Mississippi | Yes | Independent Living Waiver | Yes |
| Missouri | Yes | Independent Living Waiver (ILW); Personal Care Assistance, State Plan (Consumer-Directed Services Model) (CDS); Self-Directed Supports — DD Comprehensive, Community Support, Partnership for Hope and MOCDD waivers (SDS) | Yes |
| Montana | Yes | Self-Direct Community First Choice Services and Personal Care Services (SD-CFCS/PCS) | Yes |
| Nebraska | Yes | Personal Assistance Services (PAS) | Yes |
| Nevada | Yes | Self-Directed PCS (ISO model) | Yes |
| New Hampshire | Yes | Participant Directed and Managed Services (CFI) (PDMS) | Yes |
| New Jersey | Yes | DDD Self-Directed Services (Supports Program and Community Care Program) (SDE); Personal Preference Program (PPP) | Yes |
| New Mexico | Yes | Mi Via ICF/IID Waiver; Self-Directed Community Benefit (SDCB) | Yes |
| New York | Yes | Consumer Directed Personal Assistance Program (CDPAP); OPWDD Self-Direction | Yes |
| North Carolina | Yes | Consumer-directed care — Personal Assistant Services (CAP/Choice) | Yes |
| North Dakota | No | — | — |
| Ohio | Yes | Choices Home Care Attendant Service (C-HCAS) and participant-directed personal care | Yes |
| Oklahoma | Yes | Consumer-Directed Personal Assistance Services and Supports (CD-PASS) | Yes |
| Oregon | Yes | Consumer-Employed Provider Program (Medicaid in-home services) (HCW); Developmental Disabilities in-home supports (independent providers / Personal Support Workers) (PSW); Independent Choices Program (ICP); Spousal Pay Program (SPP) | Yes |
| Pennsylvania | Yes | CHC Participant-Directed Personal Assistance Services; In-Home and Community Support (ODP intellectual disability/autism waivers) (IHCS) | Yes |
| Rhode Island | Yes | Personal Choice Program (Self-Directed Care) | Yes |
| South Carolina | Yes | Attendant Care (Self-Directed) | Yes |
| South Dakota | Yes | Assistive Daily Living Services Waiver; South Dakota Family Support 360 Waiver (FS360) | Yes |
| Tennessee | Yes | Consumer Direction (CDTN) | Yes |
| Texas | Yes | Consumer Directed Services (CDS) option (FMSA); Consumer Managed Personal Attendant Services (CMPAS) | Yes |
| Utah | Yes | Physical Disabilities Waiver | Yes |
| Vermont | Yes | Attendant Services Program (ASP); Children's Personal Care Services (CPCS); Choices for Care Self-Directed Services (Consumer-Directed, Surrogate-Directed, Flexible Choices) | Yes |
| Virginia | Yes | Consumer-Directed (CD) Personal Assistance and Respite | Yes |
| Washington | Yes | Community First Choice (CFC) and Medicaid Personal Care (MPC) — individual provider option (IP); New Freedom Consumer Directed Services | Yes |
| West Virginia | Yes | Personal Options | Yes |
| Wisconsin | Yes | IRIS (Include, Respect, I Self-Direct) | Yes |
| Wyoming | Yes | Community Choices Waiver — Participant-Directed Services | Yes |
Employer, fiscal intermediary, family rules and pay, by state
Frequently asked questions
Which states have consumer-directed care programs?
50 of the 51 states compiled so far: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.
In which states can family be paid through consumer-directed care programs?
49 states: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming. Which relatives qualify is set by each program.
What is consumer-directed care?
The person receiving care (or their representative) hires, schedules and supervises their own aide, often a relative or friend; a fiscal intermediary handles payroll and taxes.