Self-Direction and FMS in Delaware

All states: self-direction map

Delaware self-direction at a glance

Last verified against state sources: 2026-10-13.

Which Medicaid programs in Delaware offer self-direction?

Delaware offers self-direction in four Medicaid programs: two delivered through the managed care plans and two run by the Division of Developmental Disabilities Services (DDDS). In all four the person, or someone acting for the person, chooses and directs the workers. None of the four is confirmed to give the person a budget to manage. Delaware has no single state web page for self-direction, so the details are spread across the Division of Medicaid and Medical Assistance (DMMA), DDDS and the health plans.

• Diamond State Health Plan Plus (DSHP-Plus) Self-Directed Attendant Care: serves DSHP-Plus long-term services and supports members, described by DMMA as elderly or physically disabled residents. It is not offered to people living in assisted living or nursing facilities. DMMA runs it through the managed care organizations AmeriHealth Caritas Delaware, Highmark Health Options and Delaware First Health, under the Diamond State Health Plan Section 1115 demonstration. The plans also call it Self-Directed HCBS, and DMMA's benefit list calls it consumer-directed attendant care. The member has employer authority. We did not find a statement on whether members hold a budget.
• Self-Directed Attendant Care (SDAC) for Children: serves Medicaid-eligible children and youth under 21 with a complex medical condition, an intellectual or developmental disability, or a behavioral health condition who need help with age-appropriate daily activities. DMMA runs it through the same three managed care organizations. It was added to the Section 1115 demonstration on January 1, 2023, and families can also self-direct pediatric respite. A parent, guardian or other designee has employer authority as the Employer Representative. We did not find a statement on budget authority.
• DDDS Lifespan Waiver, self-directed Respite and Personal Care: serves people with intellectual disabilities (including brain injury) and autism spectrum disorder who are enrolled in the Lifespan Waiver, a 1915(c) waiver renewed effective July 1, 2024. DDDS runs it with a contracted Agency With Choice broker. Respite and personal care are the only self-directed Lifespan services, and the option is not available with provider-managed residential habilitation. The participant has employer authority. The approved waiver does not offer budget authority.
• Pathways to Employment, Personal Care with a self-directed option: serves youth and young adults who want to work and who have intellectual disabilities, autism spectrum disorders, visual impairments or physical disabilities. It is a 1915(i) State Plan program that the state program page places with DDDS, with DMMA as the Medicaid agency. Personal care is the only participant-directed Pathways service. The participant has employer authority, and the state does not offer a participant budget.

Employer authority means the person recruits, schedules and supervises the workers. Budget authority means the person also manages a set amount of money. In the Lifespan Waiver, combined payment for respite and personal care is limited to $5,000 per participant per year under the approved waiver. The broker holds that amount as an allotment and bills against a prior authorization, and unused funds do not carry into the next fiscal year. DDDS has said it intends to raise the amount gradually as funds allow.

Who handles financial management services (FMS) in Delaware?

Delaware uses two FMS models. In the managed care programs, a fiscal/employer agent handles payroll and taxes while the member or an Employer Representative stays the employer. In the DDDS Lifespan Waiver, an Agency With Choice broker is the employer of record. A Delaware First Health payment policy names Easter Seals, JEVS and GT Independence as the FMS entities for the managed care programs, and Easterseals is the Agency With Choice broker for DDDS.

A fiscal/employer agent is an organization that handles the paperwork side of being an employer on the member's behalf. Under the plan policies it must be approved by the IRS for that role, it acts as the member's agent, and it also provides supports brokerage (hands-on help with the employer role). Agency With Choice (AWC) works differently. The broker is the employer of record and a co-employer, while the participant or a surrogate selects, schedules and supervises the workers.

• DSHP-Plus Self-Directed Attendant Care: the Delaware First Health payment policy (last revised May 2024) names Easter Seals, JEVS and GT Independence. JEVS says members are referred to it by Highmark Health Options, AmeriHealth or Delaware First Health. The member, or a designated Employer Representative, directs the service.
• Self-Directed Attendant Care for Children: the same policy names the same three entities for Medicaid self-directed attendant care and self-directed respite. The pediatric policies themselves do not name vendors. A parent, guardian or other designee serves as Employer Representative.
• DDDS Lifespan Waiver: Easterseals Delaware and Maryland's Eastern Shore is the Agency With Choice broker, a role it took over in 2021. Participants are enrolled with the AWC broker only, so there is no choice of FMS organization in this program.
• Pathways to Employment: we did not find the name of the fiscal management organization. The state plan selects a vendor fiscal/employer agent but also refers to the AWC Broker. Ask DDDS which organization serves this program.

Two points could not be confirmed for the managed care programs. We did not find a 2026 list of contracted FMS entities from DMMA or from any plan, and we did not find a statement on whether a member can choose among the three or is assigned one by the plan. Members should ask their plan case manager or care coordinator.

Who can be a paid caregiver under self-direction in Delaware?

Friends, neighbors and family members can be hired in Delaware's self-directed programs, but the rules for close family differ by program. In the children's program a legally responsible family member, such as a parent, can be paid for up to 40 hours a week. In every managed care program the Employer Representative, the person who directs the care, cannot also be the paid worker.

• DSHP-Plus Self-Directed Attendant Care: plans allow hiring a neighbor, friend or family member. The Employer Representative may not be paid to give care.
• Self-Directed Attendant Care for Children: DMMA says families may hire a neighbor, friend or family member, including a legally responsible family member. Each legally responsible family member is limited to 40 paid hours a week, and another person must direct the care and approve timesheets.
• DDDS Lifespan Waiver: relatives can qualify as paid respite or personal care providers. Guardians of adult children may be paid under the self-directed option only if approved after a Community Navigator risk screening, with a third party acting as representative. The DDDS respite page says primary caregivers and other legally responsible guardians may not pay themselves for self-directed respite, and respite caregivers must pass a criminal background check.
• Pathways to Employment: relatives may be paid for personal care named in the employment plan. Guardians may be paid under the self-directed option only for employment-related support and with Employment Navigator approval.

Hours and pay rules also differ. Workers paid through the managed care plans get overtime at 1.5 times their regular rate for hours over 40 a week, except workers who live in the member's home, and hours are not combined across plans, FMS entities or members. In the DDDS Agency With Choice program a caregiver may work no more than 29.75 hours a week combined across participants, pay is negotiated by the participant for each employee, and bonuses are not permitted.

Does EVV apply to self-directed workers in Delaware?

Yes. Electronic visit verification (EVV) applies to self-directed services in Delaware, and visits are captured through the FMS organization. Caregivers who live in the home are exempt. DMMA's published policy is that claims for EVV services that cannot be matched to an EVV visit are denied.

• Managed care programs: DMMA's EVV Terms say self-directed services are subject to EVV and that payments to self-directed caregivers flow through the FMS entities contracted by the managed care plans. A Highmark Health Options policy has the FMS collect timesheets that include EVV requirements. GT Independence says its app is used to track time and submit timesheets. We did not find which EVV tools JEVS and Easter Seals use for these programs.
• DDDS Lifespan Waiver: DDDS says EVV applies to self-directed respite and personal care delivered in the home, except when the employee lives with the participant. DDDS names Therap as its alternate EVV vendor and HHAeXchange (formerly Sandata) as the aggregator, the system that collects visit records for the state. EVV data is supporting documentation before a claim is submitted.
• Pathways to Employment: we did not find an EVV rule specific to self-directed personal care in this program.

Two points could not be confirmed. DMMA's EVV page states the claim denial policy as effective July 1, 2025, but we could not confirm when denials began in practice. We also did not find any source that says a worker's paycheck is withheld for a missing visit. The published rule is about the claim, not the paycheck. For either question, ask the FMS organization or the member's plan.

What is changing next for self-direction in Delaware?

We did not find a confirmed upcoming change to self-direction in Delaware as of the last check. Two state procurements are open questions and could affect FMS organizations, but neither had a confirmed award when we checked. Treat both as items to watch, not as settled changes.

• EVV contract: DMMA issued RFP HSS-27-005, which seeks an EVV contractor that only aggregates visit data, under a Provider Choice model that must support member-directed services. The RFP gives an estimated project start at the beginning of 2027. That timing is an estimate, and we did not find an award.
• Agency With Choice contract: DDDS re-bid the Agency With Choice contract under RFP HSS-26-019, expecting one prime vendor. The go-live date DDDS anticipated has passed, and we could not confirm an award or a change of vendor. Easterseals still presents itself as the Agency With Choice broker.

If you work with either program, ask DDDS or DMMA for the current status before planning around these procurements.

Delaware self-direction sources

• Delaware First Health: Payment Policy, Self-Directed Attendant Care for LTSS (DE.PP.003)
• Delaware First Health: Clinical Policy DE.CP.MP.05 (Self-Directed Attendant Care for Children)
• DMMA: Children with Medical Complexity
• DDDS: Lifespan Waiver (1915(c), renewal effective July 1, 2024)
• DDDS: Agency With Choice RFP HSS-26-019, Addendum 1
• DDDS: Pathways to Employment State Plan Amendment
• DMMA: EVV Terms
• DMMA: Electronic Visit Verification
• DMMA: EVV RFP HSS-27-005

Related reading

• Self-Directed Medicaid Home Care Services in 2026
• Understanding Self-Direction and FMS
• Self-Direction Fiscal Intermediary: A Guide for Participant-Directed Care
• 5 Big Challenges in Self-Directed Care And How FMS Providers Can Solve Them
• Self-direction in every state (map)
• Delaware EVV requirements

Page history

• October 13, 2026: Page rewritten and checked against state sources.

This page is a reference, not legal advice. State rules change, so confirm details with the state before you act on them.

Ankota provides software for FMS organizations and agencies that support self-direction. If you would like to talk through your program, contact Ankota or read more about Ankota's self-direction and FMS software.