Self-Direction and FMS in Illinois

All states: self-direction map

Illinois self-direction at a glance

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

Which Medicaid programs in Illinois offer self-direction?

Illinois has two separate self-directed tracks, both run by the Illinois Department of Human Services (IDHS). In the Home Services Program, customers hire and supervise their own Individual Providers and the state pays them. In Home-Based Support Services for people with developmental disabilities, families get a budget and can hire workers directly through a fiscal agent called ACES$. There is no single statewide self-direction page or office, so the rules have to be read track by track.

• Home Services Program (HSP), Individual Providers: serves people with severe disabilities who are under age 60 when they apply and are at risk of nursing facility placement, including people with brain injury and people with HIV or AIDS. It covers three waivers (Persons with Disabilities, Persons with Brain Injury, and Persons with HIV or AIDS) and is run as one program by the IDHS Division of Rehabilitation Services. Individual Providers are Personal Assistants and individually hired CNAs, LPNs and RNs. The customer has employer authority. We did not find a state statement that gives the customer a dollar budget to manage, so budget authority is not confirmed. Customers in a managed care plan use Individual Providers under the same rules, with the plan's care coordinator in the place of the HSP counselor.
• Home-Based Support Services (HBS), Adults with Developmental Disabilities waiver: serves adults 18 and older with an intellectual or developmental disability who live at home or with family. It is run by the IDHS Division of Developmental Disabilities (DDD). The customer has both employer authority and budget authority. The budget is monthly, set at three times the monthly SSI amount plus 5 percent, and money not used in the month does not carry over.
• Home-Based Support Services (HBS), Support Waiver for Children and Young Adults with Developmental Disabilities: serves children and young adults ages 3 through 21 with intellectual or developmental disabilities who live at home with family. It is run by DDD. The family has both employer authority and budget authority. The budget is annual, based on two times the monthly SSI amount plus 5 percent, with room to spend up to four times the SSI amount in a single month and carryover only within the calendar year.

Employer authority means the customer or family recruits, hires, schedules and supervises the workers. Budget authority means they also manage a set amount of money for services. In both DD waivers a family can hire workers directly, use a provider agency, or do both, and the DDD consumer handbook for Home-Based Services describes an optional service called Self-Direction Assistance for help with the employer role. In both tracks the Department of Healthcare and Family Services (HFS) is the state Medicaid agency.

We did not find a self-directed option on state pages for the Persons who are Elderly waiver (the Community Care Program). To check whether one exists today, ask the Illinois Department on Aging Senior HelpLine at 1-800-252-8966.

Who handles financial management services (FMS) in Illinois?

It depends on the track. The Home Services Program has no FMS vendor: the state runs payroll itself, and the customer is the employer. In DD Home-Based Support Services, one state-contracted Fiscal/Employer Agent, ACES$, handles payroll for every directly hired worker. Families in the DD track do not pick among FMS vendors, because ACES$ is the only one.

A Fiscal/Employer Agent is an organization that handles the paperwork side of being an employer. It processes new hires, runs payroll and files the employer taxes, while the person receiving services (or someone acting for them) stays the legal employer.

• Home Services Program: the customer is the employer and hires, schedules and monitors the hours of the Individual Providers. The customer approves the time, IDHS Home Services Payroll processes the pay, and the Illinois Office of Comptroller issues the W-2s. Wages are not negotiated one by one. They are set by a 2023 to 2027 agreement between the state and SEIU Healthcare Illinois and Indiana.
• DD Home-Based Support Services (both waivers): the customer, a guardian or a representative is the Employer of Record. ACES$ (Avenues to Consumer Employer Services and $upports), operated by MyCIL, handles new-hire paperwork, background checks, payroll and taxes. The state's EVV manual says ACES$ is not the employing entity. Anyone who directly hires a Personal Support Worker must use ACES$.
• Pay rates in the DD track: the employer and the worker agree on the wage, and it has to fit within the budget.

We did not find a notice that the ACES$ contract is up for renewal or rebid. For questions about the DD arrangement, DDD lists DHS.DDDComments@illinois.gov and (888) 337-5267.

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

Relatives can be paid in both tracks, with limits. In DD Home-Based Support Services a spouse cannot be the paid worker, and a parent can be paid only in the children's waiver and only once the participant is over 18. In the Home Services Program a Legally Responsible Individual (LRI) can be paid only under a signed LRI Agreement, capped at 40 hours a week.

• DD Home-Based Support Services (both waivers): family members can work as Personal Support Workers. Three people cannot: the participant's spouse, the participant's minor child, and the person acting as Employer of Record.
• Children and Young Adults Support Waiver: under bulletin DD.22.015, in effect since January 1, 2023, a parent can be paid as a Personal Support Worker only when the participant is over 18. For a participant under 18, a parent or other legally responsible person cannot be paid.
• Home Services Program: an LRI may be a paid provider only within a signed LRI Agreement. Paid hours are limited to the extraordinary care hours in the service plan or 40 hours a week, whichever is less, and there is no overtime exception. The state's own definition of who counts as an LRI is in a policy document we could not read, so we do not restate it here. Ask the HSP counselor or the managed care plan's care coordinator, or write to DHS.HSPWaiver@illinois.gov.

Hours and overtime also differ by track. Home Services Program Individual Providers earn time and a half over 40 hours in a Sunday to Saturday week, may not go over 60 hours a week without an approved overtime exception for the customer, and may not work more than 16 hours in any 24. They also earn paid time off, one hour for every 40 hours worked, up to 40 hours a year. DD Personal Support Workers must be paid 1.5 times their rate over 40 hours a week, and that cost has to fit within the monthly service maximum.

Does EVV apply to self-directed workers in Illinois?

Yes. Electronic visit verification (EVV) applies in both tracks, through two different systems. Home Services Program Individual Providers clock in and out in the Department's Sandata system. DD workers hired through ACES$ record their time in the ACES$ CareAttend app. In both tracks, missing EVV can delay or hold pay, but we did not find a rule that denies pay automatically.

• Home Services Program: Individual Providers clock in and out by a Santrax call from the customer's registered phone or in the Sandata Mobile Connect app. Customers edit and approve the hours in the EVV portal. A paper time sheet is still required. The HSP EVV policy says noncompliance may delay paychecks, and three EVV occurrences in six months may lead to Individual Providers being replaced by a homemaker agency.
• DD Home-Based Support Services: since September 1, 2023, every service billed through ACES$ needs an EVV record captured in CareAttend. A landline phone system (IVR) is allowed only as an approved alternate, for poor coverage or a religious exemption. The DDD EVV manual says manual or modified entries do not automatically stop pay. DDD may hold payments if required EVV training is not finished within a month, and a year of repeated noncompliance can end self-direction.
• Live-in caregivers: in the DD track, a live-in caregiver is exempt from EVV once DDD approves a Live-in Caregiver Attestation, which has to be renewed every year. We did not find a published live-in exemption for Home Services Program Individual Providers. To ask, write to DHS.EVV@illinois.gov.

Since July 1, 2025, the Home Services Program has also run automated compliance checks on the 16-hour rule, the LRI policy and monthly service plan use. IDHS says the goal is to retire paper time sheets, though the paper time sheet requirement is still in the policy today.

What is changing next for self-direction in Illinois?

The Home Services Program Personal Assistant rate is scheduled to rise to $20.75 an hour on January 1, 2027, or on federal approval if that comes later. The step is part of the 2023 to 2027 agreement between the state and SEIU, which also lists $19.50 from January 1, 2026 and $20.00 from July 1, 2026. Each step is payable on its listed date or on federal approval, whichever is later, so check the state's rate page for the rate in effect.

Two other items are announced but not final:

• A new EVV contract for the Home Services Program: IDHS reports in its FY25 report that the program is procuring a new long-term EVV contract. No vendor and no date are given, and we did not find a statement on whether it would change the Sandata system that Individual Providers use today.
• Proposed waiver amendments: HFS has posted proposed amendments for the Adults with Developmental Disabilities waiver, the Persons with Disabilities waiver and the Persons who are Elderly waiver, with a proposed start in early 2027. They are proposals, not approved changes. We could not read their content, so we do not know whether they touch self-direction, paid family caregivers or rates. Ask HFS or the IDHS division that runs the waiver.

Illinois self-direction sources

• IDHS: Home Services Program
• IDHS: Home Services Program customer and provider compliance (employer role, EVV, LRI Agreement)
• IDHS: Home Services Program Individual Providers and the SEIU agreement
• IDHS: Home Services Program Personal Assistant rates
• IDHS: Home Services Program EVV policy
• IDHS: Home Services Program FY25 report
• IDHS Division of Developmental Disabilities: Home-Based Services consumer handbook
• IDHS Division of Developmental Disabilities: bulletin DD.22.015 (paying parents in the Children's Support Waiver)
• IDHS Division of Developmental Disabilities: EVV manual for self-directed services

Related reading

• Illinois EVV Update: What Home Care Agencies Need to Know About the HHAeXchange Expansion
• Understanding Self-Direction and FMS
• Self-Direction Fiscal Intermediary: A Guide for Participant-Directed Care
• Self-Directed Medicaid Home Care Services in 2026
• Self-direction in every state (map)
• Illinois 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.