Self-Direction and FMS in Georgia
All states: self-direction map
In short: Self-direction runs through five waivers (NOW, COMP, CCSP, SOURCE, ICWP); the participant is the employer and picks a fiscal intermediary; EVV is required.
Georgia self-direction at a glance
| Self-directed programs | NOW and COMP (Participant Direction), plus CCSP, SOURCE and ICWP (Consumer-Directed Personal Support Services) |
|---|---|
| FMS model | Fiscal intermediary. NOW and COMP also allow a co-employer model with a provider agency. |
| FMS vendors | Acumen Fiscal Agent and Continuum Fiscal Services. PPL also publishes a NOW and COMP program. |
| Who is the employer | The participant or a representative is the employer of record |
| Can family be paid | In NOW and COMP, yes with limits. Not a spouse, a parent of a minor or the representative. Other relatives need DBHDD approval. |
| EVV for self-directed workers | Yes. Workers clock in and out in their fiscal intermediary's EVV tool. |
| Budget authority | Yes in NOW and COMP. Not confirmed for CCSP, SOURCE or ICWP. |
Last verified against state sources: 2026-10-13.
Which Medicaid programs in Georgia offer self-direction?
Georgia offers self-direction in five Medicaid waivers: the New Options Waiver (NOW), the Comprehensive Supports Waiver Program (COMP), the two parts of the Elderly and Disabled Waiver Program (CCSP and SOURCE), and the Independent Care Waiver Program (ICWP). The state uses two names for it. In NOW and COMP it is called Participant Direction, and in CCSP, SOURCE and ICWP it is called Consumer-Directed Personal Support Services. In every one of them the participant, or a representative, hires and supervises the workers.
- NOW and COMP Participant Direction: serves people with intellectual and developmental disabilities who live in their own home or a family home. The Department of Behavioral Health and Developmental Disabilities (DBHDD) runs it day to day, and the Department of Community Health (DCH) is the Medicaid agency. The participant has both employer authority and budget authority. DBHDD lists 23 services that can be participant directed, including Community Living Support, respite, community access, supported employment, transportation and Individual Directed Goods and Services.
- Elderly and Disabled Waiver Program (CCSP and SOURCE), Consumer-Directed Personal Support Services: serves adults 21 and over who are elderly or functionally impaired and meet a nursing facility level of care. DCH runs it, and Area Agencies on Aging and SOURCE sites handle intake and case management. The consumer has employer authority. We did not find a statement on whether the consumer also manages a budget.
- Independent Care Waiver Program (ICWP), Consumer-Directed Personal Support Services: a 1915(c) waiver that serves adults aged 21 to 64 with severe physical disabilities or traumatic brain injury. DCH runs it, and Alliant Health Solutions handles applications and assessment as DCH's contractor. The member has employer authority. We did not find a statement on budget authority here either.
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. Participant direction in NOW and COMP is a way of receiving waiver services, not a separate waiver. DBHDD's Participant Direction page says a person must be in NOW or COMP, live in their own or a family home, choose a Financial Support Services provider, complete one day of required training and sign a Memo of Understanding. The Support Coordinator records the choice in the Individual Service Plan and budget.
Georgia has no single statewide self-direction page. For CCSP, SOURCE and ICWP the option is described in DCH fact sheets (Elderly and Disabled Waiver and ICWP) and in the provider manuals. The DCH fact sheet describes the consumer-directed option as the same as Personal Support Services, except that the consumer hires and supervises workers of choice.
Who handles financial management services (FMS) in Georgia?
Georgia uses a fiscal intermediary model with a choice of vendors. The participant or a representative is the legal employer, and a fiscal intermediary issues paychecks and handles taxes on the employer's behalf. Acumen Fiscal Agent and Continuum Fiscal Services both list all five waivers on their Georgia pages, and DBHDD names both for NOW and COMP. Participants choose their fiscal intermediary.
A fiscal intermediary is the organization that handles the paperwork side of being an employer: payroll, tax filing and billing Medicaid for the hours worked. Georgia uses two names for this service. In NOW and COMP it is called Financial Support Services, and the organizations are often called fiscal agents. In CCSP, SOURCE and ICWP, DCH calls it a Financial Management Services provider.
- Legal employer: a 2023 DBHDD training presentation says the participant or representative is enrolled as the employer with the IRS and needs an Employer Identification Number (EIN). The fiscal intermediary is an enrolled Medicaid provider and is not the employer.
- NOW and COMP: DBHDD's page names Acumen Fiscal Agent and Continuum Fiscal Services. Financial Support Services are required for participants who direct services and use budget authority, and the cost comes out of the participant's individual budget.
- CCSP, SOURCE and ICWP: the consumer must choose a Financial Management Services provider. We did not find a DCH list of these providers. Acumen and Continuum each list these waivers on their own sites.
- Co-employer model (NOW and COMP only): a participant can instead share the employer role with a traditional provider agency. In that model the agency runs payroll and bills, and Financial Support Services are not used. This description comes from a 2016 DBHDD document, so ask DBHDD how the model works today.
Note: Public Partnerships LLC (PPL) ended Financial Support Services for NOW and COMP on October 1, 2021. PPL now publishes a Georgia NOW and COMP program page again, with enrollment forms dated April 2025 and a 2026 payroll schedule. DBHDD's own page still names only Acumen and Continuum. Before choosing PPL, confirm its status with the DBHDD Participant Direction Team at participant.direction@dbhdd.ga.gov.
On pay, PPL's April 2025 employer agreement for NOW and COMP says the worker's pay rate is set while the Individual Service Plan is developed and may not exceed the authorized rate. Employers must pay at least minimum wage, and any overtime owed comes out of the participant's budget. Employer taxes and workers' compensation also come out of the budget. Acumen's 2023 training for support coordinators put that cost at about 18.33 percent on top of the hourly wage.
Who can be a paid caregiver under self-direction in Georgia?
In NOW and COMP, some family members can be paid, but only with approval. A spouse cannot be paid. Neither can a parent or legally responsible person of a participant under 18, or the person serving as the participant direction representative. Other relatives can be hired only after DBHDD approves a Family Hire Request.
- Who is barred in NOW and COMP: DBHDD's Family Hire Request Form (2024) bars spouses and parents or legally responsible persons of minors, and says the representative cannot be hired as staff. DBHDD's 2023 transition plan also listed court-appointed legal guardians as prohibited.
- Who can be approved: the 2023 plan says other family members within the third degree by blood, adoption or marriage, aged 18 or older, may be paid when DBHDD approves.
- What approval takes: the request must meet at least two of three conditions: a lack of qualified employees in the area, extraordinary specialized skills, or clear cost effectiveness. The pay rate cannot be more than a traditional provider bills for the same service.
- Common violations: a DCH presentation from 2021 lists unapproved family hires among the most common self-direction policy violations. It also lists authorizing a family hire for more than 40 hours in a 7 day period, paying more than a traditional provider, and a family member owning or leasing the home where Community Living Support is provided.
- Background checks: NOW and COMP self-directed workers must pass a fingerprint based criminal background check before starting work. People with a felony conviction or a substantiated history of abuse, neglect or exploitation cannot be hired.
The looser family hire rules from the pandemic (Appendix K) ended in NOW and COMP on November 11, 2023. After that date only family hires approved by DBHDD could continue.
For CCSP, SOURCE and ICWP, we did not find the current rule on which relatives can be paid under Consumer-Directed Personal Support Services. The rule is in the DCH provider manuals for those waivers, which we could not open. Ask the case manager, the fiscal intermediary, or DCH before assuming the NOW and COMP rules apply.
Does EVV apply to self-directed workers in Georgia?
Yes. Electronic visit verification (EVV) applies to self-directed Community Living Support in NOW and COMP and to Consumer-Directed Personal Support Services in CCSP, SOURCE and ICWP. Workers clock in and out in the EVV tool that their fiscal intermediary provides. EVV data is required to process the claims for those services, and the fiscal intermediary submits the claims for the employer.
- NOW and COMP: EVV applies to Community Living Support only, including the co-employer version of that service. Other participant-directed services are not on the DCH EVV list in the sources we read.
- Continuum Fiscal Services: requires all employees working Community Living Support or Personal Support Services hours to clock in and out in the Netsmart Mobile Caregiver+ app. Continuum stopped using the ALORA app on March 1, 2026 and returned to Mobile Caregiver+.
- Acumen Fiscal Agent: provides DCI as its EVV system for Georgia employers and sends the data to the state's system itself, so Acumen clients do not work with Netsmart directly. This comes from a May 2023 DBHDD training presentation.
- PPL: its April 2025 employer agreement says employers and workers must record shifts in PPL's own EVV system (the Time4Care app, a web portal or the participant's land line).
- Landline check-in: using a landline phone for EVV needs DCH approval.
Two points could not be confirmed. We did not find an EVV exemption for live-in caregivers in any source. We also did not find a plain statement on whether a worker's own paycheck depends on a verified visit, or only the Medicaid claim. The sources say EVV data is required to process claims and stop there. For either question, ask the fiscal intermediary or email DCH at evv.medicaid@dch.ga.gov. A DCH presentation for self-directed members covers the basics.
What is changing next for self-direction in Georgia?
We did not find an announced upcoming change to self-direction in Georgia as of our last check on October 13, 2026. The most recent confirmed change is on the EVV side: Continuum Fiscal Services stopped using the ALORA app on March 1, 2026 and returned to Netsmart Mobile Caregiver+.
One open item is worth watching. PPL left NOW and COMP in 2021 and now publishes a Georgia program page again, but DBHDD's page has not been updated to name it. If DBHDD adds PPL to its list, NOW and COMP participants would have three fiscal intermediaries to choose from. Until then, treat DBHDD's Participant Direction page as the place to check.
Waiver renewals can also change the rules for participant direction. We did not review any pending renewal for this page, so check the DCH waiver programs page for current notices.
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Who to ask about self-direction in Georgia
Questions about self-direction in Georgia are best put to the state. Start with DBHDD Participant Direction (NOW and COMP waivers). Published contact: participant.direction@dbhdd.ga.gov (DBHDD Participant Direction Team, NOW and COMP); evv.medicaid@dch.ga.gov (DCH EVV questions).
Georgia self-direction sources
- Georgia DBHDD: Participant Direction (NOW and COMP waivers)
- Georgia DBHDD: NOW/COMP Family Hire Request Form (2024)
- Georgia DBHDD: Participant direction training presentation for support coordinators (May 31, 2023)
- Georgia DBHDD: Financial Support Services description (2016)
- Georgia DCH: Elderly and Disabled Waiver Program fact sheet
- Georgia DCH: EVV implementation presentation for self-directed members
- Georgia DCH: Employer's EVV checklist for Continuum self-directed members
- Acumen Fiscal Agent: Georgia
- Continuum Fiscal Services
Related reading
- Self-Directed Medicaid Home Care Services in 2026
- Understanding Self-Direction and FMS
- Why Do Self-Directed Participants Choose Your FMS as Their Fiscal Intermediary?
- Self-Direction Fiscal Intermediary: A Guide for Participant-Directed Care
- Self-direction in every state (map)
- Georgia EVV requirements
Other states with a choice of FMS vendors
Alaska, Colorado, Idaho, Kentucky, Louisiana, Maryland, Minnesota, North Carolina, Texas, Utah. See every state on the self-direction map.
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.
