The Complexity of Self-Direction for FMS Agencies
When Tanya started her Financial Management Services (FMS) agency in Texas, she had no idea how complex participant-directed services could get. Managing timesheets, authorizations, EVV, payer billing, and caregiver enrollment manually across 200 participants quickly overwhelmed her growing team.
She needed software, but most systems were built for traditional home care, not self-direction.
Tanya’s story mirrors what FMS agencies across the country experience every day. The self-directed Medicaid model is empowering for individuals, but it’s incredibly demanding on the back office. The right technology isn’t just a nice-to-have—it’s the only way to scale efficiently and stay compliant.
In this guide, we’ll walk through what matters in self-direction software, compare top vendors, and explain why Ankota has become a preferred choice for FMS agencies in multiple states.
What FMS Agencies Need from Self-Direction Software
Self-direction isn’t like traditional home care. FMS agencies serve as the financial and administrative backbone for participants who manage their care. That means software needs to:
- Handle enrollment and document management for both participants and caregivers
- Support Electronic Visit Verification (EVV) for states where it’s required
- Track authorizations and budgets across multiple payers
- Allow timesheet and visit approval flows with multiple stakeholders
- Generate clean, exportable files for payroll and billing
- Support multi-language access for participants and caregivers
- Offer participant and family-facing portals or apps
- Be flexible enough to support different state models and waivers
Tip: Most off-the-shelf home care platforms can’t handle these complexities. Choose a platform that was built or adapted for self-direction.
Why Software Matters More in Self-Direction
In traditional home care, agencies assign caregivers, manage schedules, and control workflows. In self-direction, participants (or their representatives) do the hiring, firing, and scheduling. The FMS agency sits in the background, but carries all the compliance burden.
Without software to enforce timesheet validation, EVV, and budget tracking, things can go off the rails quickly.
Example:
In Missouri, an FMS agency was using a mix of Excel, PDFs, and DocuSign to manage timesheets. As their census passed 500 participants, error rates in EVV submissions soared, leading to thousands of denied claims. After moving to Ankota, they integrated their processes end-to-end and saw a 96% drop in rejected visits.
Features to Look For in Self-Direction Software
| Feature | Why It Matters | Ankota Support |
|---|---|---|
| Participant & Caregiver Onboarding | Simplifies enrollment and ensures compliance | ✅ Digital packets, document tracking |
| EVV Compliance | Required in most states | ✅ Works with Sandata, HHAeXchange, Therap |
| Timesheet Approval Workflow | Ensures timesheet accuracy before payroll | ✅ 3-level approval with reminders |
| Budget & Authorization Tracking | Prevents overspending, alerts on limits | ✅ Per-participant budget tracking |
| Payroll & Billing Exports | Saves hours of manual work | ✅ Exports are formatted for major processors |
| Mobile App for Families | Empowers participants, ensures transparency | ✅ Family app launching July 2025 |
| Support for Multiple State Models | Essential for multi-state agencies | ✅ Custom rules per waiver/state |
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Vendor Comparison Table
Let’s compare Ankota with some of the most commonly considered self-direction software vendors:
| Vendor | Self-Direction Ready | EVV Integration | Budget Tracking | Timesheet Workflow | Customization | Pricing Transparency |
|---|---|---|---|---|---|---|
| Ankota | ✅ Built for FMS | ✅ Sandata, HHA, Therap | ✅ Participant-level | ✅ Multi-level approval | ✅ High | ✅ Transparent |
| Connecteam | ❌ Not FMS-specific | ❌ No EVV integration | ❌ Limited | ❌ Basic timesheets | ❌ Low | ✅ Low-cost |
| SDSoftware | ❌ GPS tracking only | ❌ Not EVV compliant | ❌ No budget control | ✅ Timesheets only | ❌ Basic | ✅ Transparent |
| SpokeChoice | ✅ FMS-focused | ✅ (Limited to some states) | ✅ Yes | ✅ Yes | ❌ Limited customization | ❌ Unpublished |
| Santrax (Sandata) | ✅ Required in many states | ✅ Native | ❌ No advanced workflows | ❌ Rigid | ❌ Not customizable | ❌ Not disclosed |
Real-World Story: From Chaos to Control in Colorado
Let’s talk about David, who manages a self-direction program in Colorado. His team was manually reconciling EVV visits and authorizations across three systems. Families were frustrated. Caregivers were missing payroll. And his team was burning out.
David switched to Ankota in early 2024. Within 90 days:
- Their visit-to-payroll cycle shrank from 14 days to 5
- 87% of timesheets were approved without staff intervention
- Customer service calls dropped by over 40%
"It’s like night and day. We finally have one system that fits the way we work—and families love the new app," David shared.
Tips for Evaluating Self-Direction Software
✔ Ask vendors if they’ve worked with your specific waiver program
✔ Ask how they support your EVV aggregator (Sandata, Therap, etc.)
✔ Request a demo with your workflows—not a generic home care demo
✔ Look for flexible approval flows for families and representatives
✔ Confirm support for different languages and accessibility features
✔ Get clarity on file formats for payroll and billing
How Ankota Stands Out for FMS Agencies
Ankota isn’t just a home care system with an EVV module tacked on. We’ve spent years working closely with FMS agencies across the country to build features that matter:
- Alt EVV integrations with all major aggregators
- Custom workflows based on your state’s unique requirements
- Caregiver-first mobile app with offline mode and reminders
- Multi-level approvals with audit trails
- Per-participant budgeting and alerts
- End-to-end automation from clock-in to payroll export
We work in partnership with FMS agencies—offering flexibility, support, and a roadmap aligned with the future of self-direction.
States Where Ankota Supports Self-Direction
| State | Aggregator | Ankota Integration |
|---|---|---|
| California | Sandata | ✅ Alt EVV supported |
| Colorado | HHAeXchange | ✅ Full API integration |
| Georgia | Tellus (CareBridge) | ✅ In development |
| Texas | Therap | ✅ Operational |
| Missouri | Sandata | ✅ Live with multiple FMS agencies |
| New York | eMedNY (Sandata) | ✅ Custom format supported |
| Indiana | Sandata | ✅ Available |
| Arizona | AuthentiCare | ✅ Available |
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The Future of Self-Direction Is Technology-Driven
As Medicaid waiver programs expand and participants demand more control, the future of self-direction lies in automation and transparency. Agencies that invest in the right technology today will:
- Reduce operational overhead
- Improve participant satisfaction
- Stay ahead of audits and compliance
- Scale faster across multiple states
You Don’t Have to Piece It All Together
Tanya, David, and hundreds of others have realized something important: self-direction doesn’t have to mean chaos. With the right software partner, you can serve your participants well and run a smooth, scalable business.
Ankota is proud to help FMS agencies deliver on the promise of self-directed care, without burning out their staff or blowing their budgets.
Ready to See It in Action?
📧 Have questions? Email us anytime at John.Starling@ankota.com
Ankota's mission is to enable the Heroes who keep older and disabled people living at home to focus on care because we take care of the tech. If you need software for home care, EVV, I/DD Services, Self-Direction FMS, Adult Day Care centers, or Caregiver Recruiting, please contact Ankota.
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