Self-Direction and FMS in Maryland

All states: self-direction map

Maryland self-direction at a glance

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

Which Medicaid programs in Maryland offer self-direction?

Maryland offers self-direction in three Medicaid programs: the DDA Community Pathways Waiver, Community First Choice (CFC) and Community Personal Assistance Services (CPAS). All three are run by the Maryland Department of Health and are paid fee for service, not through managed care plans. In each one the participant has both employer authority and budget authority, and works with a Financial Management and Counseling Services (FMCS) contractor.

• DDA Community Pathways Waiver, Self-Directed Services Delivery Model: a 1915(c) waiver that serves children and adults with intellectual and developmental disabilities who live in their own home, a family home, or with others under a lease or Shared Living arrangement. It is run by the Developmental Disabilities Administration (DDA). The participant has employer authority for Community Development Services, Employment Services, Nursing Support Services, Personal Supports, Respite Care Services, Support Broker Services and Transportation, and budget authority for all self-directed services. Participants set wages within a reasonable and customary range and can move money across approved budget lines.
• Community First Choice (CFC), self-directed model: a 1915(k) state plan option that serves Medicaid members of any age or disability type who need an institutional level of care and live in the community. It is run by the Office of Long Term Services and Supports (OLTSS). The approved plan lets participants choose the agency model or the self-directed model, effective October 1, 2023. The participant has employer authority and budget authority: the participant recruits, hires, supervises and dismisses providers, sets the amount paid within state and federal pay rules, and approves payment requests. No cash is given to participants.
• Community Personal Assistance Services (CPAS), self-directed model: a 1915(j) state plan option for people eligible for Medicaid state plan personal care. It is statewide with no enrollment cap and is run by OLTSS. CMS approved the plan amendment on March 14, 2024, with an effective date of July 1, 2023. The participant has employer authority and budget authority: participants recruit, hire, train, supervise and fire their personal assistance providers, set pay rates, and have a service plan and a service budget. A representative may direct services for the participant.

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. In CPAS the budget cannot be used for items that take the place of human assistance.

Two DDA details are worth knowing. Community Pathways is now the only DDA waiver, because the Family Supports and Community Supports waivers merged into it on October 6, 2025. Since that same date, people choosing the Self-Directed Services Delivery Model must complete self-direction training before they enroll.

For CFC and CPAS, we did not find a state web page that describes the self-directed model or says how many people use it. The approved plans are the source for the rules above. Ask OLTSS or a supports planner how to enroll.

Who handles financial management services (FMS) in Maryland?

Maryland calls FMS Financial Management and Counseling Services (FMCS), and private contractors procured by the Maryland Department of Health provide it. The state uses a fiscal/employer agent model: the participant is the common law employer, and the FMCS contractor acts as the participant's agent for payroll and taxes. Participants choose their FMCS contractor. The DDA waiver lists three: GT Independence, Public Partnerships LLC and Fello.

A fiscal/employer agent is an organization that handles the paperwork side of being an employer. It checks that workers are qualified, processes their time, withholds and files taxes, and pays workers and invoices on the participant's behalf. The counseling part of FMCS covers help with the budget and training for the participant. Maryland does not offer agency with choice, a model where an agency shares the employer role.

• Legal employer: the participant is the common law employer (the employer of record). The FMCS contractor does not employ the workers.
• DDA Community Pathways Waiver: FMCS is required to self-direct, and participants pick one of three providers listed on DDA's FMCS page. Monthly fees for July 2026 to June 2027 are $123 for GT Independence, $93.42 for Public Partnerships LLC and $220 for Fello, with a 14 percent employer tax rate at each. Fees change every July 1, and today they are paid from the participant's self-directed budget.
• CFC: the approved plan says financial management comes through one or more FMCS contractors procured by the state, and that supports planners refer interested participants to the FMCS contractor of their choice. The contractor handles payroll, employment taxes and insurance, counsels on the budget and trains the participant.
• CPAS: the approved plan uses vendor organizations that act as the employer's agent under IRS Code section 3504. FMCS contractors also review and approve service plans and survey 10 percent of their participants.

We did not find a state page that names the FMCS contractors for CFC or CPAS. The three names above are confirmed by the state only for the DDA waiver. If you self-direct under CFC or CPAS, ask your supports planner or OLTSS which contractors you can choose from.

The DDA waiver also has Support Brokers. A Support Broker is a person who helps the participant with the employer role. Using one is optional in most cases, but it is required when the participant pays a relative, a designated representative or a legal guardian as staff. A designated representative cannot be the participant's Support Broker.

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

Family members can be paid in Maryland, but the rules differ by program. In the DDA waiver, relatives, legally responsible persons and legal guardians can each be paid for no more than 40 hours a week. CFC lets participants hire family members. CPAS does not allow legally liable relatives to be paid.

• DDA Community Pathways Waiver: relatives, legally responsible persons and legal guardians may provide paid waiver services, up to 40 hours a week each. The participant must attest that there is a lack of other qualified staff, using a DDA attestation form. Support Broker services are required when one of these people is paid staff.
• CFC: the approved plan says the participant may permit family members or any other individuals to provide services if they meet the qualifications the participant sets. Providers need first aid and CPR certification and a background check before hire. We did not find a narrower rule for spouses, parents of minor children or guardians. One may exist in state regulation or OLTSS guidance, so ask OLTSS before hiring.
• CPAS: the state chose not to permit participants to hire legally liable relatives as paid personal assistance providers. Ask OLTSS who counts as a legally liable relative in your case.

Wages follow program limits. DDA participants set wages within a reasonable and customary range. DDA has delayed its new Reasonable and Customary Wage Standards for self-directed staff: participants can choose to freeze wages at June 30, 2026 levels, and allowable wages stay at those levels until CMS approves the pending waiver amendment described below.

We could not read the current DDA Self-Directed Services Manual (revised May 11, 2026) as text, so details such as overtime for family staff and separate wage limits for family staff are not confirmed here. The manual is posted on DDA's self-directed forms page. Check it, or ask your FMCS provider or DDA regional office, before you set a family member's schedule.

Does EVV apply to self-directed workers in Maryland?

Yes. Electronic visit verification (EVV) applies to self-directed workers in all three programs. Workers record their time in the EVV system of the participant's FMCS contractor, not in the Department's own EVV system, which agency providers use. State regulation pays for EVV services only when they are recorded in the approved system, with one exception for live-in caregivers.

• DDA Community Pathways Waiver: EVV has been required for self-directing participants since January 1, 2023. It applies to self-directed Personal Supports and Respite. Staff clock in and out in the EVV system of the participant's FMCS provider, and time that was not clocked needs a Missing Time Request. See DDA's EVV guidance for self-directed services.
• CFC and CPAS: personal assistance providers for self-directing participants must use the EVV system of the FMCS contractor the participant selected. In CPAS, workers also enter their time in that contractor's system.
• Live-in caregivers: since July 1, 2023, personal assistance providers who live with the participant may be exempted from EVV in CFC and CPAS. In the DDA waiver, exempt live-in caregivers still bill through the FMCS provider's system.
• Does pay depend on it: yes. COMAR 10.09.36.03-2 reimburses EVV services only if they are recorded in the approved system, or through an approved alternate timekeeping process when the live-in caregiver exemption has been granted and elected.

We did not find a state source that names the EVV product each FMCS contractor uses, or one that lays out the steps to request the live-in exemption. Ask the participant's FMCS contractor for both.

What is changing next for self-direction in Maryland?

A waiver amendment still under CMS review would change self-directed budgets in the DDA waiver and add a weekly cap on paid family caregivers. It is not approved yet. DDA says nothing in the amendment takes effect until CMS approves it, so today's rules stand for now.

DDA sent Community Pathways Waiver Amendment #4 to CMS on July 1, 2026. CMS asked for more information on September 25, 2026. According to DDA's amendment page, DDA has responded and expects CMS to finish its review within 90 days, but that is an expectation and not a set date.

If CMS approves it as proposed, the amendment would:

• Change how self-directed budgets are built. The proposal would use new self-directed service rates for Person-Centered Plans with an effective date of January 2027 or later. That is the state's target, and it has already moved once from an earlier September 2026 target.
• Add a weekly limit on paid family caregivers, which DDA calls the 60/40 rule and says state law requires. DDA's easy-to-read overview says it added exceptions for emergencies and unexpected staffing shortages, left paid time off out of the cap, and widened the definition of relative to include in-laws. We did not find a plain statement of the exact hours in the rule, so we do not give a number here.
• Move FMCS costs from participant budgets to DDA. DDA says participants would still have a choice of at least three qualified FMCS providers.
• Replace self-directed vendors with individual providers and move away from unlicensed vendors. DDA says it is giving vendors technical help to apply for qualified provider status.

We did not find any upcoming change to self-direction in CFC or CPAS as of the last check.

Maryland self-direction sources

• Maryland DDA: Self-Directed Service Model
• Maryland DDA: Financial Management and Counseling Services
• Maryland DDA: Appendix E, Amendment #4 proposal submitted to CMS July 1, 2026
• CMS: Maryland state plan amendment MD-23-0012 (Community First Choice)
• CMS: Maryland state plan amendment MD-23-0014 (Community Personal Assistance Services)
• COMAR 10.09.36.03-2 (electronic visit verification)
• Maryland DDA: Community Pathways Waiver Amendment #4 2026
• Maryland DDA: Amendment #4 easy-to-read overview
• Maryland DDA: Reporting form attestation (April 27, 2026)

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
• Why Do Self-Directed Participants Choose Your FMS as Their Fiscal Intermediary?
• Self-direction in every state (map)
• Maryland EVV requirements

Other states with a choice of FMS vendors

Alaska, Colorado, Georgia, Idaho, Kentucky, Louisiana, 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.