Self-Direction and FMS in Florida
All states: self-direction map
In short: Two self-direction tracks: APD's CDC+ for developmental disabilities and the plan-run Participant Direction Option in Medicaid long-term care.
Florida self-direction at a glance
| Self-directed programs | Consumer-Directed Care Plus (CDC+) and the Participant Direction Option (PDO) in Medicaid managed care |
|---|---|
| FMS model | Fiscal/employer agent (F/EA) |
| FMS vendors | Varies by program. APD itself for CDC+. For PDO, each health plan picks a vendor (PPL and GT Independence confirmed). |
| Who is the employer | The participant, or a representative acting for the participant |
| Can family be paid | Yes in both programs. The unpaid representative cannot also be a paid worker. |
| EVV for self-directed workers | Yes. CDC+ uses APD's Mains'l EVV. PDO workers use the plan vendor's tool. |
| Budget authority | Yes in CDC+. No in Long-Term Care PDO, where the plan sets the pay rate and hours. |
Last verified against state sources: 2026-10-13.
Which Medicaid programs in Florida offer self-direction?
Florida has two self-direction tracks. Consumer-Directed Care Plus (CDC+) serves people with developmental disabilities and is run by the Agency for Persons with Disabilities (APD). The Participant Direction Option (PDO) is part of Medicaid managed care, overseen by the Agency for Health Care Administration (AHCA) and delivered by the health plans. Florida has no single state page that covers both.
- Consumer-Directed Care Plus (CDC+): serves people with developmental disabilities who are enrolled in APD's iBudget waiver and choose CDC+ instead. APD runs it, and AHCA is the state Medicaid agency. The participant has both employer authority and budget authority. APD's CDC+ page says participants become employers, manage a monthly budget, may appoint a representative and may use providers outside the Medicaid network. The federal basis is a 1915(j) self-directed personal assistance services option in Florida's Medicaid state plan, effective July 1, 2010.
- Participant Direction Option (PDO), Long-Term Care: serves Long-Term Care plan enrollees who live in their own home or a family home and have at least one PDO service on the plan of care. The PDO services are adult companion care, attendant care, homemaker, intermittent and skilled nursing, and personal care. AHCA oversees it and each managed care plan with Long-Term Care benefits delivers it. The participant has employer authority: they hire, train, supervise and dismiss their direct service workers. The participant does not manage a budget, because the health plan pays workers at a set rate for the hours approved in the plan of care.
- Participant Direction Option (PDO) for ICMC benefits: a newer use of PDO for people with intellectual and developmental disabilities in managed care. AHCA's PDO Roster Report summary shows this benefit type was added on September 9, 2025 (first labelled IDD, now ICMC), with Personal Supports, Skilled Nursing and Companion as its PDO services. We did not find a state source that spells out the employer and budget rules for this group, the regions it covers or its federal authority. Ask AHCA or the health plan.
Employer authority means the participant recruits, hires, schedules and supervises the workers. Budget authority means the participant also manages a set amount of money for services. AHCA requires every plan with Long-Term Care benefits to offer PDO to any enrollee with an eligible service, both at the start and at each yearly reassessment.
Who handles financial management services (FMS) in Florida?
It depends on the program. Florida uses a fiscal/employer agent (F/EA) model in both tracks, which means the participant or a representative is the employer and an agent handles payroll and taxes on the employer's behalf. For CDC+, the state agency APD is the agent. For PDO, each health plan is responsible for F/EA services and may hand them to a vendor it selects.
Important: The PDO vendor depends on the health plan, and the list below is not complete. We did not find the vendors for Molina Healthcare or UnitedHealthcare, and Sunshine Health's own PDO page names no payroll company. Confirm the current vendor with the plan before you rely on this list.
- Legal employer: the participant, or a representative the participant appoints. APD's background screening page calls the CDC+ consumer the employer of record. AHCA's PDO training says the participant serves as the employer.
- CDC+: Florida's approved state plan page for CDC+ describes APD as the fiscal/employer agent. APD's current pages show an APD-hosted timesheet and invoice system and an APD pay schedule. There is no outside FMS vendor for participants to pick.
- PDO, Florida Community Care and Simply Healthcare: Public Partnerships LLC (PPL) has a PDO program page for each of these two plans. Its Florida Community Care page lists separate enrollment packets for Long-Term Care and ICMC workers.
- PDO, Humana Healthy Horizons, Sunshine Health and Aetna Better Health: GT Independence lists these three plans on its Florida page.
- Who chooses: the health plan chooses the PDO vendor. A participant does not pick among FMS vendors.
AHCA's PDO training deck sets out what the plan must do as the agent. The plan must hold a separate federal employer identification number (FEIN) for representing participants as employers, obtain an FEIN for each participant, and submit any F/EA subcontract to AHCA. The plan must also fund workers' compensation cover for participants' workers and pay for Level 2 background screening for at least one representative and one worker per service each contract year. Workers are paid at least twice a month, by direct deposit or prepaid card, and the plan must tell the participant the set pay rates.
Who can be a paid caregiver under self-direction in Florida?
Family members can be hired and paid in both programs. In PDO, participants may hire any qualified person they choose, including neighbors, family members or friends. The main limit we confirmed is about the representative: a person who acts as the unpaid representative cannot also be a paid worker.
- PDO: a representative cannot be paid for acting as representative and cannot be a direct service worker. Workers do not have to be in the health plan's network. Attendant care and intermittent or skilled nursing workers must be a licensed RN or LPN. Adult companion, homemaker and personal care workers need no certification or license.
- PDO, spouses and guardians: we did not find a statement on whether a spouse or a legal guardian can be a paid PDO worker. AHCA's PDO Guidelines and PDO Manual may cover it. Ask the health plan, or write to AHCA at flmedicaidmanagedcare@ahca.myflorida.com.
- CDC+: Florida's approved state plan page for CDC+ elects to let participants hire legally liable relatives as paid providers of personal assistance services. APD's background screening page says screening is mandatory for all CDC+ employees, family members included, and for all representatives other than people who represent themselves.
- CDC+, older guidance: an APD question and answer page from 2009 says a family member who provides paid services cannot also be the representative, and that parents may provide companion services. That page is old, so confirm the current rule with CDC+ Customer Service at 1-866-761-7043.
We did not find a published weekly hour cap for family caregivers in either program. In PDO, the approved hours come from the participant's plan of care.
Does EVV apply to self-directed workers in Florida?
Yes, with differences by program. Electronic visit verification (EVV) applies to CDC+ providers of Personal Care Assistance, In-Home Supports and Respite, who log visits in APD's Mains'l EVV. In PDO, workers use the tool supplied by the health plan's vendor. We did not find an AHCA rule that ties PDO pay to an EVV-verified visit.
- CDC+, whose system: APD's CDC+ EVV page says providers must use the Mains'l EVV app, web application or phone line. The consumer or representative then verifies the visits at apd.mainsl.com. Agency or vendor providers with more than one employee verify their own.
- CDC+, live-in exemption: providers who meet the Department of Labor definition of a live-in provider are not required to use EVV.
- CDC+, pay: EVV does not replace timesheets or invoices. Rule 65G-12.002 makes the agency-designated EVV a condition for payment under CDC+. APD's CDC+ EVV FAQ (dated October 2022) says EVV is not a payroll system and that providers are still paid when shifts were not approved in the EVV portal. Ask APD how the two are applied today.
- PDO: PPL says EVV is used in the Florida Community Care and Simply Healthcare PDO programs, with timesheets submitted and approved in its Time4Care app. GT Independence says its GT App keeps workers EVV compliant. AHCA's PDO training describes payroll based on timesheets and does not mention EVV.
Three PDO points could not be confirmed. We did not find a statement on whether PDO pay depends on a verified visit, whether live-in PDO workers are exempt, or whether PDO visit data is sent to a health plan's EVV system. For any of these, ask the health plan or its F/EA vendor.
What is changing next for self-direction in Florida?
We did not find an announced upcoming change to self-direction in Florida as of our last check on October 13, 2026. No new program, vendor change or rule with a future effective date turned up in the state sources we reviewed. Several recent changes are already in place and are worth knowing about.
- PDO now reaches ICMC benefits: AHCA added IDD (now labelled ICMC) as a benefit type in its PDO Roster Report on September 9, 2025, with Personal Supports, Skilled Nursing and Companion as the PDO services.
- A disenrollment note was removed: the September 2026 update to the same report guide removed the note that required plans to disenroll PDO participants whose workers had not received a paycheck for more than 30 calendar days.
- Current PDO materials date from February 2025: AHCA's PDO forms, guidelines, manual and training deck on its agency-approved contract materials page all carry that date, which matches the start of the 2025 to 2030 managed care contracts.
- PPL login change for Simply Healthcare: PPL has moved Simply Healthcare PDO users to MyAccount logins, and old Time4Care credentials stop working once a user registers. PPL also posted new enrollment packets in May and June 2026. PPL gives no effective date for the change.
Because PDO vendors are chosen plan by plan, a vendor can change without a statewide announcement. Check with the health plan when a contract year turns over.
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Who to ask about self-direction in Florida
Questions about self-direction in Florida are best put to the state. Start with APD Consumer-Directed Care Plus (CDC+). Published contact: CDC+ Customer Service 1-866-761-7043; PDO questions to flmedicaidmanagedcare@ahca.myflorida.com.
Florida self-direction sources
- Agency for Persons with Disabilities: Consumer-Directed Care Plus (CDC+)
- Agency for Persons with Disabilities: CDC+ Electronic Visit Verification
- Agency for Persons with Disabilities: CDC+ background screening
- CMS: Florida state plan amendment 10-010, 1915(j) self-directed personal assistance services
- AHCA: Long-Term Care PDO training deck (February 2025)
- AHCA: Agency-approved contract materials, 2025 to 2030 SMMC plans
- AHCA: Participant Direction Option (PDO) Roster Report summary
- Public Partnerships LLC: Florida PDO, Florida Community Care
- GT Independence: Florida
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)
- Florida 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.
