Self-Direction and FMS in Idaho

All states: self-direction map

Idaho self-direction at a glance

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

Which Medicaid programs in Idaho offer self-direction?

Idaho offers self-direction through three Medicaid routes. Adults with developmental disabilities use My Voice, My Choice, children with developmental disabilities use Family-Directed Services, and people on the Aged and Disabled (A&D) Waiver can direct their personal care through a Fiscal Intermediary agency. All three are run by the Idaho Department of Health and Welfare (DHW), Division of Medicaid. The two developmental disability programs give the participant or family an individual budget, and the A&D route does not describe one.

• My Voice, My Choice: the self-directed option on the Adult Developmental Disabilities Waiver, a 1915(c) waiver. It serves adults 18 and older with developmental disabilities who qualify for the DD Waiver. The Bureau of Developmental Disability Services runs it. The participant has both employer authority and budget authority. The participant must hire a support broker and choose a fiscal employer agent. See DHW's Self-Directed Services page.
• Family-Directed Services: the family-directed option under the Children's Home and Community Based Services State Plan Option, a 1915(i) benefit. It serves children with developmental disabilities who live at home with a parent or court-appointed legal guardian and have an individual budget. The Children's Developmental Disabilities program runs it. The parent or legal guardian has both employer authority and budget authority. Community support workers work one on one with the child, not in groups. See DHW's Family-Directed Services page.
• Participant-directed A&D Waiver services through a Fiscal Intermediary (FI) agency: an option on the Aged and Disabled Waiver, a 1915(c) waiver. It serves adults 65 and older, and adults 18 to 64 with physical or other disabilities, who meet nursing facility level of care. The Bureau of Long Term Care runs it. The participant or a representative recruits, selects, trains, supervises and can dismiss the caregiver, which is employer-style authority, but the FI agency is the legal employer. We did not find a statement that the participant manages an individual budget.

Employer authority means the participant chooses and manages the workers. Budget authority means the participant also manages a set amount of Medicaid money for services. In both developmental disability programs the workers are called community support workers, and the person who helps the participant plan and manage the budget is called a support broker. In adult self-direction the support broker is an employee of the participant.

The rules for the consumer-directed option now sit in IDAPA 16.03.26, sections 800 to 846. DHW moved them there from IDAPA 16.03.13 on July 1, 2026 and said the rules themselves did not change. Some DHW manuals still show the old rule number.

Who handles financial management services (FMS) in Idaho?

It depends on the program. In My Voice, My Choice and Family-Directed Services, the participant or family picks one of four fiscal employer agents: Consumer Direct, Acumen, Palco or Valentine CPA. In the A&D Waiver, a Fiscal Intermediary agency approved by DHW does the job, and that agency is the caregiver's legal employer. We did not find a public list of approved Fiscal Intermediary agencies.

A fiscal employer agent (FEA) is an organization that handles the paperwork side of being an employer. It holds the budget, pays workers and vendors, withholds and pays taxes, and reports on the budget. The participant stays the employer. A Fiscal Intermediary (FI) agency works differently: it hires the caregiver the participant chose and takes on the legal employer role itself.

• My Voice, My Choice: the participant is the employer, or the legal guardian if there is one. The participant chooses among the four FEAs. Workers can be employees or independent contractors. Workers' compensation is not required, and unemployment insurance is handled through the FEA.
• Family-Directed Services: the parent or legal guardian is the employer. The same four FEAs serve this program. The FEA pays workers from approved timesheets, pays vendors and taxes, and reports on the budget.
• A&D Waiver: the caregiver is a legal employee of the FI agency. The agency bills Medicaid, runs payroll and taxes, carries liability insurance and does background checks. The participant or a representative recruits, selects, trains and supervises the caregiver. A signed memorandum of understanding divides the tasks between them.

Switching FEAs takes planning. In adult self-direction a change of FEA needs 60 days written notice and can only take effect at the end of a fiscal quarter. Valentine CPA is the newest of the four. DHW approved it on August 26, 2025.

Pay in the developmental disability programs is set by agreement. The employer negotiates a rate with each worker in an employment agreement, within fair market rates. Raises are allowed but bonuses are not, and families cannot add pay or benefits out of pocket because Medicaid is payment in full. The Support Broker Manual gives a maximum support broker wage of $18.72 per hour.

For the A&D Waiver, to learn which agencies act as Fiscal Intermediary agencies, ask the DHW Bureau of Long Term Care.

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

The rules differ by program. In adult self-direction, relatives can be paid and so can a legal guardian, with limits, but a spouse cannot. In children's Family-Directed Services, a parent or legal guardian cannot be paid. In the A&D Waiver and personal care, spouses and parents of minor children can no longer be the paid caregiver.

• My Voice, My Choice: a paid community support worker cannot be the participant's spouse. A legal guardian can be a paid community support worker, but not for the participant responsibilities set in rule and not for duties the guardianship or conservatorship order already requires. A caregiver whose own home the participant lives in must have that home certified as a Certified Family Home.
• Support brokers in adult self-direction: the participant's parents, guardian, payee, conservator or spouse cannot be the support broker, and participants cannot be their own support broker.
• Family-Directed Services: a parent or legal guardian may not be a paid community support worker or support broker. A worker also cannot be paid for duties the parent or guardian is legally responsible for.
• A&D Waiver: spouses and parents of minor children cannot be the paid caregiver. We did not find a published list of which other relatives (adult children, other family members or guardians) may be hired through an FI agency. Ask the DHW Bureau of Long Term Care.

Hours are capped in adult self-direction. Under rule changes effective July 1, 2025, a community support worker cannot work more than 12 hours in a day without Department authorization. Support brokers are capped at 3,120 paid hours per calendar year across all participants, and the Support Broker Manual says a support broker cannot be paid for more than 40 hours of work per week. Transportation support is limited to 1,800 miles a year unless otherwise authorized. We did not find a DHW statement on overtime for community support workers.

Does EVV apply to self-directed workers in Idaho?

Partly. We did not find an electronic visit verification (EVV) requirement for My Voice, My Choice or Family-Directed Services, where workers are paid from signed time entries sent to the fiscal employer agent. EVV does apply to A&D Waiver services delivered through a Fiscal Intermediary agency.

• My Voice, My Choice: DHW says the community support worker's time sheet is the only documentation required. The participant submits signed time entries to the FEA, which runs payroll every two weeks.
• Family-Directed Services: workers are paid from timesheets signed by the worker and the parent.
• A&D Waiver: the FI agency must train the caregiver and the participant on the EVV system, and the participant helps train the caregiver on it. The agency chooses its own EVV vendor. Claims for A&D attendant care, homemaker and respite services need matching EVV data in the state's aggregator before the agency bills.

The position on the developmental disability programs rests on DHW's EVV FAQ from February 2021, which says adult and children's developmental disability services were determined to be out of EVV scope. That FAQ does not name My Voice, My Choice or Family-Directed Services, and we did not find a newer statement. FMS organizations that want it in writing should ask the Bureau of Developmental Disability Services at BDDSSB@dhw.idaho.gov.

We did not find a published EVV exemption for live-in caregivers in Idaho.

What is changing next for self-direction in Idaho?

We did not find an upcoming change to self-direction in Idaho as of our last check on October 13, 2026. No new rule, vendor change or EVV expansion for the self-directed programs has a published date. Several changes have already taken effect, and one bill is worth watching.

• July 1, 2026: the consumer-directed rules moved to IDAPA 16.03.26, sections 800 to 846, with no change to the rules themselves. FEA employment agreements and the waiver of liability form were updated the same day.
• July 1, 2026: Idaho Medicaid stopped approving new service animal requests and annual service animal care in self-direction budgets. Existing authorizations run until the current plan expires.
• August 26, 2025: Valentine CPA was approved as a fourth fiscal employer agent.
• July 15, 2025: the Family Personal Care Services program ended, so spouses and parents of minor children can no longer be the paid caregiver for personal care and attendant care.
• July 1, 2025: the 12 hours a day cap for community support workers, the 3,120 hour yearly cap for support brokers and the 1,800 mile transportation limit took effect in adult self-direction.

One item is not settled. House Bill 807 (2026), which would give legislative approval for certain family personal care services, was introduced on March 2, 2026 and referred to the House Health and Welfare Committee on March 3. The bill page shows no later action. It has not changed the rules described above, and we did not find any DHW plan to resume paying legally responsible individuals.

Idaho self-direction sources

• Idaho Department of Health and Welfare: Self-Directed Services (My Voice, My Choice)
• Idaho Department of Health and Welfare: Family-Directed Services
• Idaho DHW: adult self-direction information document (July 2026)
• Idaho DHW: Support Broker Manual
• Idaho DHW: Family-Directed Services guidance document
• Idaho DHW Bureau of Long Term Care: Fiscal Intermediary Memorandum of Understanding (December 2022)
• Idaho DHW: Electronic Visit Verification FAQ (February 2021)
• Idaho DHW: Long-term care provider enrollment and general information
• Idaho DHW: notice of self-direction rule changes effective July 1, 2025

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)
• Idaho EVV requirements

Other states with a choice of FMS vendors

Alaska, Colorado, Georgia, 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.