Self-Direction and FMS in Louisiana

All states: self-direction map

Louisiana self-direction at a glance

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

Which Medicaid programs in Louisiana offer self-direction?

Louisiana offers self-direction in four Medicaid home and community based waivers: the Community Choices Waiver, the New Opportunities Waiver (NOW), the Residential Options Waiver (ROW) and the Children's Choice Waiver. All four are 1915(c) waivers run by offices of the Louisiana Department of Health (LDH). In each one the participant, or a representative acting for the participant, is the employer who hires and manages the workers. The employer also sets wages and schedules inside a budget approved in the plan of care.

• Community Choices Waiver (CCW), Self-Direction option: run by the LDH Office of Aging and Adult Services (OAAS). The participant or a responsible representative has employer authority and sets wages and schedules within the yearly budget and the prior authorized units. Personal Assistance Services (PAS) is the only CCW service that can be self-directed. The participant must use a self-directed service at least once every 90 days to stay in the option. The handbook we read does not restate who is eligible for the waiver, so check eligibility with OAAS.
• New Opportunities Waiver (NOW), Self-Direction option: serves people with intellectual and developmental disabilities. It is run by the LDH Office of Intellectual and Developmental Disability Supports (OIDD). The beneficiary or an authorized representative is the employer and makes decisions within an individual budget. The handbook says the NOW has a soft cap and that hours can be flexed within a quarter. Self-direction cannot be combined with Supported Independent Living.
• Residential Options Waiver (ROW), Self-Direction option: serves people with intellectual and developmental disabilities and is run by OIDD. The beneficiary or an authorized representative is the employer. A ROW beneficiary may self-direct all or part of Community Living Supports and take other services from a provider agency. The ROW is a capped waiver, so hours can be flexed within a quarter but not beyond the yearly budget.
• Children's Choice Waiver, Self-Direction option: serves children and youth with intellectual and developmental disabilities, and LDH says participants can stay in the waiver until age 21. It is run by OIDD. The authorized representative, usually a parent, is the employer. Children's Choice is a capped waiver, and hours can be flexed across the whole plan year.

Employer authority means the participant or representative recruits, hires, schedules and supervises the workers. In Louisiana the budget side is narrower than in some states. The state documents we read describe setting wages and schedules inside the approved hours and yearly budget, and we did not find a confirmed option to buy goods and services with that budget. We also did not find which NOW and Children's Choice services can be self-directed in the handbook text we could read, so ask the support coordinator.

Two handbooks hold the day to day rules. OAAS publishes the Community Choices Self-Direction handbook (reissued July 11, 2024). OIDD publishes one Self-Direction handbook (issued March 16, 2023) for NOW, ROW and Children's Choice. OIDD is the new name of the office that used to be called the Office for Citizens with Developmental Disabilities (OCDD), so older documents still carry the OCDD name. LDH's self-direction page lists only these four waivers. We did not find a self-directed option in the Supports Waiver, the Adult Day Health Care Waiver or state plan Long Term Personal Care Services.

Who handles financial management services (FMS) in Louisiana?

Two companies handle financial management services for Louisiana self-direction: Acumen Fiscal Agent and Morning Sun Financial Services. Louisiana uses a fiscal/employer agent (FEA) model, which means the FEA runs payroll while the participant or their representative stays the legal employer of the workers. The same two FEAs serve all four waivers, and participants choose one of them.

A fiscal/employer agent is the organization that handles the paperwork side of being an employer. It acts as the payroll agent for the employer, and it pays the workers for time the employer has approved. LDH's manual text describes a vendor FEA model in which the beneficiary is the employer of record with their own federal employer identification number.

• Legal employer: the participant, or a responsible or authorized representative, is the employer of record. In Children's Choice the employer is the authorized representative, usually a parent.
• Vendors by program: LDH's self-direction page says the department has an agreement with Acumen Fiscal Agent and Morning Sun Financial Services, and both serve the Community Choices, NOW, ROW and Children's Choice waivers.
• Choice: both handbooks tell participants to choose one of the two FEAs. In the Community Choices Waiver the participant picks an FEA on a Freedom of Choice form and can switch later.
• Start of pay: the OIDD handbook says a worker is not paid for any work done before the FEA issues the Good to Go date (after background and database checks clear) and before the plan of care start date. The FEA runs payroll at least every two weeks.

The employer sets each worker's hourly wage within program guidelines, and the wage must be at least minimum wage. The Community Choices handbook says the employer must pay time and a half for hours over 40 in a Sunday to Saturday work week, and that the budget and units are not increased to cover overtime. We did not find the current FEA contract terms or end dates, so ask LDH if that matters to your planning.

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

Family members can be paid workers in Louisiana self-direction, with limits. In every waiver the person acting as employer or representative cannot also be the paid worker. A legally responsible individual, such as a spouse or the parent of a minor child, can be paid only when extraordinary care is needed. The details differ between the Community Choices Waiver and the three OIDD waivers.

• Community Choices Waiver: the employee cannot be the participant, the employer or the responsible representative. The employee can be the participant's curator, tutor, legal guardian, power of attorney or spouse if that person meets the worker requirements. A spouse counts as the legally responsible individual and can be the paid worker only if Extraordinary Care criteria are met and OAAS approves a request filed on the LRI/Spouse Request Form (OAAS-PF-24-002).
• NOW, ROW and Children's Choice: since November 11, 2023 the employer and the employee cannot be the same person. Authorized representatives, legally responsible individuals and legal guardians may be the employer, but not also the employee. LDH's attestation instructions define a legally responsible individual as the parent of a minor child, a spouse, or a curator or continued tutor of an adult, and say that person can be paid staff only when extraordinary care is needed.
• Paid caregiver attestation (OIDD waivers): every family member who lives in the home and works as paid staff, and every legally responsible individual wherever they live, must sign a paid caregiver attestation after the support coordinator reviews best interest and extraordinary care. In a 2025 quarterly Q and A, LDH said the attestation is due every year.

Curator and tutor are Louisiana legal terms. A curator is a person a court names to act for an adult, and a tutor plays a similar role for a minor (a continued tutor keeps that role after the child becomes an adult). Extraordinary care, in plain words, means care beyond what a spouse or parent would normally be expected to give.

We did not find a final, published weekly hour limit for family workers. Draft manual text on that point is covered in the last section. For a parent of a minor in the Children's Choice Waiver, the attestation instructions allow pay only under the extraordinary care rule, so confirm the specific case with the support coordinator.

Does EVV apply to self-directed workers in Louisiana?

Yes. LDH says anyone who receives paid help through self-direction under an approved waiver service plan must use electronic visit verification (EVV). Workers clock in and out through the EVV offered by their fiscal/employer agent, and the employer approves the time. Repeated failure to use EVV can end a participant's place in self-direction.

• Whose system: the EVV comes through the FEA, not through the state's agency EVV system. Acumen's Louisiana EVV sheet and Morning Sun's EVV sheet both name DCI as the system.
• Three methods: both handbooks allow a mobile app, a call from the participant's landline, or a FOB device (a small device that shows a code, which Morning Sun describes as an option for areas without internet access). The OIDD handbook requires the worker to clock in and out of a shift by the same method.
• Missed punches: the OIDD handbook says missed punches are entered through the DCI portal on the FEA's website, and the employer approves all hours.
• If EVV is not used: both handbooks set the same steps. The employer gets a warning and more training, the records are reviewed again after 30 calendar days, and continued non-use can lead to termination from self-direction.
• Shared supports: when one worker supports two participants at once, the worker clocks in for one participant under the shared service code and a matching manual entry is made for the second. LDH's August 2026 self-direction newsletter says payment is denied if matching entries by the same employee are not made for both.

Self-direction sits outside LDH's agency EVV policy and its 80 percent utilization threshold. The self-direction EVV rules are in the OAAS and OIDD handbooks instead.

Two points could not be confirmed. We did not find a published EVV exemption for live-in caregivers or any other group of self-directed workers. We also did not find a statement that time recorded outside EVV goes unpaid. The sources describe manual entry, employer approval, and the warning and removal steps above. For either question, ask your FEA (Acumen or Morning Sun) or the LDH self-direction staff listed on the state page.

What is changing next for self-direction in Louisiana?

We did not find a dated, confirmed change to Louisiana self-direction as of our last check. The one item to watch is a revised OIDD Self-Direction Handbook for the NOW, ROW and Children's Choice waivers. In a September 2026 quarterly meeting Q and A, OIDD said the revised handbook is almost ready for distribution, with training modules to follow by section. No release date was given.

Until the new handbook is posted, the March 16, 2023 handbook is still the one linked from the LDH page and its rules stand. We did not find a statement on what the revision will change.

A second item concerns hours for family workers. LDH posted manual text for NOW and ROW in 2023 as redline drafts with no final issue date. That draft text says family members employed in self-direction must meet the same standards as unrelated staff and, if they live in the home, may work no more than 40 hours a week per beneficiary. We could not confirm that wording in the final published manual chapters, so treat the 40 hour limit as likely but not confirmed, and ask the support coordinator before you schedule a live-in family worker.

We did not find a current procurement for the fiscal/employer agents or any announced change of vendor. Acumen and Morning Sun are the FEAs today.

Louisiana self-direction sources

• Louisiana Department of Health: Medicaid Self-Direction
• LDH Office of Aging and Adult Services: Community Choices Waiver Self-Direction handbook (reissued July 11, 2024)
• LDH Office of Intellectual and Developmental Disability Supports: Self-Direction handbook (issued March 16, 2023)
• LDH: Self-Direction paid caregiver attestation with instructions (December 7, 2023)
• LDH: Self-Direction quarterly questions and answers (2025)
• LDH: Self-Direction quarterly meeting Q and A (September 2026)
• LDH: Self-Direction newsletter (August 2026)
• LDH: Acumen Louisiana EVV methods
• LDH: Morning Sun EVV one-page guide

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)
• Louisiana EVV requirements

Other states with a choice of FMS vendors

Alaska, Colorado, Georgia, Idaho, Kentucky, 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.