Self-Direction and FMS in Minnesota

All states: self-direction map

Minnesota self-direction at a glance

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

Which Medicaid programs in Minnesota offer self-direction?

Minnesota has two live self-direction tracks and one that is being phased out. Consumer Directed Community Supports (CDCS) is a budget-based option inside five waivers and the Alternative Care program. Community First Services and Supports (CFSS) began October 1, 2024 and has a budget model in which the person is the employer. The Consumer Support Grant (CSG) continues only for people who have not yet moved to CFSS.

• CDCS on the disability waivers (BI, CAC, CADI and DD): serves children and adults on the Brain Injury, Community Alternative Care, Community Access for Disability Inclusion and Developmental Disabilities waivers. It is run by the Minnesota Department of Human Services (DHS), Disability Services Division, with counties and Tribal Nations as lead agencies. The person has both employer authority and budget authority.
• CDCS on the Elderly Waiver (EW): serves adults 65 and over on the Elderly Waiver, including people enrolled in managed care. It is run by the DHS Aging and Adult Services Division, with counties, Tribal Nations and managed care organizations as lead agencies. The person has both employer authority and budget authority. The budget is set from the person's assessed case mix.
• CDCS on the Alternative Care (AC) program: serves older adults on Alternative Care, a program for people who are not on full Medical Assistance waiver services. It is run by the DHS Aging and Adult Services Division with counties and Tribal Nations. The person has both employer authority and budget authority.
• CFSS budget model: serves people of any age who qualify for personal care level services, live in the community and can direct their own care or have a representative. It is also open to people on a waiver, on Alternative Care, or age 65 and over in managed care. DHS runs it with counties, Tribal Nations and managed care organizations as lead agencies. The person is the employer, receives a budget instead of service units, and has both employer authority and budget authority.
• CFSS agency model: serves the same people as the budget model. The person directs the care, helps choose the worker and writes the service delivery plan, but the CFSS provider agency is the employer and pays the workers. The lead agency authorizes units, not dollars, so the person has neither employer authority nor budget authority.
• Consumer Support Grant (CSG): a state-funded grant for people eligible for Medical Assistance home care who are not on a waiver, Alternative Care, MSHO or MSC+. DHS runs it with counties and Tribal Nations. The person has both employer authority and budget authority. CSG is being replaced by CFSS.

Employer authority means the person hires, trains, schedules, supervises and dismisses the workers. Budget authority means the person also decides how to spend an approved amount of money. Under CDCS that budget can pay for workers, goods, traditional waiver services and some alternative services, as the DHS CDCS Policy Manual describes. The county or Tribal Nation approves the community support plan and the budget. CDCS is not available to people who live in licensed foster care, customized living or integrated community supports, or who are in the Minnesota Restricted Recipient Program.

In CFSS, the person picks a consultation services provider, who explains the two models and helps with the service delivery plan. The lead agency approves the plan. DHS describes both models on its CFSS page.

Who handles financial management services (FMS) in Minnesota?

Minnesota does not use a single statewide vendor. DHS enrolls a panel of FMS providers, and the person chooses one. The state uses a vendor fiscal/employer agent model (DHS shortens this to VF/EA), which means the FMS provider handles payroll, taxes and billing while the person stays the legal employer of the workers.

An FMS provider is the organization that does the paperwork side of being an employer. In Minnesota it processes time records, pays the workers, files payroll taxes, helps the person obtain workers' compensation coverage, starts worker background studies and bills DHS or the managed care organization. State law says CFSS support workers are not employees of the FMS provider.

• Legal employer: the person is the employer in CDCS, the CFSS budget model and CSG. In the CFSS agency model the provider agency is the employer, and an FMS provider is used only to process purchases of goods and services.
• Choosing a provider: a person must select an FMS provider before using CDCS. The lead agency gives the person the list. DHS has said it does not cap the number of FMS providers.
• Fees: each FMS provider sets its own fees, which are paid from the person's budget. The DHS page links to each provider's contact details and fee schedule.
• Union agreement: people who employ workers under CSG or the CFSS budget model, and their FMS providers, must follow the SEIU Healthcare Minnesota and Iowa collective bargaining agreement.

The DHS FMS provider page listed 15 approved and enrolled providers when we last checked: Accord, Accra Consumer Choice, Acumen Fiscal Agent, Alliance Health Services, Aspen FMS, Best Care, CDI (Consumer Directions Inc.), FMS Heritage Care Services Inc., GT Independence, Life Fountain FMS, Lifeworks Services Inc., Mains'l Financial Management Services, MRCI WorkSource, Orion ISO and Partners in Community Supports Inc. (PICS). The list can change, so use the DHS page as the current record.

We did not find whether any managed care organization limits the choice of FMS provider for its members who use Elderly Waiver CDCS or CFSS. Members in managed care should ask their care coordinator.

Minnesota used to allow an agency with choice arrangement, a form of shared employment, for CDCS and CSG. When DHS replaced the older fiscal support entities with FMS providers, it moved to a single payroll model in which the participant is the employer and holds an employer identification number.

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

Minnesota allows some close family members to be paid. A spouse, or the parent, stepparent or legal guardian of a minor, can be a paid worker in CFSS and for CDCS personal assistance. Weekly hours are capped, and the cap counts CDCS and CFSS hours together.

• Hour limits: a spouse can be paid for up to 60 hours in seven days. A sole parent of a minor can be paid for up to 60 hours in seven days. When more than one parent is paid, each can work up to 40 hours, with 80 hours combined.
• CFSS: since October 1, 2024, a spouse or the parent, stepparent or legal guardian of a minor can be the paid CFSS worker. State law (Minn. Stat. 256B.85, subd. 7b) sets the hour limits and caps their pay at the CFSS support worker rate. This applies in the agency model too, where the person helps select the worker.
• CDCS: personal assistance is the only CDCS service a spouse or a parent of a minor can be paid for. The person served must have at least one assessed dependency in an activity of daily living, and the paid work cannot be something a spouse or parent would typically do. The negotiated pay rate cannot be more than the DHS level 4 CFSS rate (wages, benefits and payroll taxes included), and mileage is not reimbursed.
• Who cannot be the worker: the DHS CFSS questions and answers page says a paid legal guardian, or the person's responsible party or participant's representative, cannot be the paid worker.

The CDCS rules above come from the DHS policy page on paying a spouse or parent of a minor. We did not review the rules for other relatives, such as adult children, siblings or grandparents. For those, and for any case that involves a guardian, ask the lead agency (the county, Tribal Nation or managed care organization) or the FMS provider.

Does EVV apply to self-directed workers in Minnesota?

Yes. Electronic visit verification (EVV) applies to the personal care type services that people self-direct in Minnesota: CDCS personal assistance, the CFSS budget model and the Consumer Support Grant. Workers use the EVV system chosen by the FMS provider the person picked. There is no exemption for live-in caregivers, and claims are not denied up front for a missing verified visit.

• Which services: CDCS personal assistance (billing code T2028 with the U1 modifier), the CFSS budget model (T1019:UB) and CSG (T2025). EVV does not cover every CDCS purchase, such as goods. The CFSS agency model (T1019:U9) also requires EVV, through the agency's system.
• Whose system: FMS providers may use the free state system from HHAeXchange or a third-party system that sends visits to the HHAeXchange aggregator, which collects visit data for the state. The DHS FMS provider page lists the EVV vendor each FMS provider selected. Examples on that list include Cashe Software, Navigation Plus, Direct Care Innovations, HHAeXchange and Caregiver by GT Independence.
• Live-in caregivers: they are excused only from recording visits in real time. They still must enter their visit data in the EVV system at least once a day, according to the HHAeXchange Minnesota information page.
• Does pay depend on it: not at the moment a claim is submitted. DHS checks EVV in post-payment review, which can lead to money being taken back, and holds providers, FMS providers included, to an 80 percent EVV compliance rate for visits billed from July 1, 2026. See the DHS EVV page.

FMS services were the first EVV phase in Minnesota, starting in June 2022 with CDCS personal assistance and CSG. The CFSS budget code has been in scope since October 1, 2024. Two points could not be confirmed: whether CDCS code T2028 billed without the U1 modifier is in scope, and whether CDCS under Alternative Care follows the same EVV rules. For either, ask the FMS provider or DHS.

What is changing next for self-direction in Minnesota?

People still on PCA or the Consumer Support Grant must finish moving to CFSS, in either the agency model or the budget model, by September 30, 2027. After that date PCA and CSG end. DHS set this deadline in an announcement on May 12, 2026, which extended an earlier one.

People move to CFSS at their assessment, as the DHS transition page explains. A few details matter for FMS providers and families:

• Budgets: CSG pays only the state share of funding, while the CFSS budget model includes state and federal funds. DHS says a person's CFSS budget is about twice the CSG budget.
• CSG used in place of home care nursing: this cannot be converted to CFSS. DHS offers these people a MnCHOICES assessment to find other services.
• Extended PCA and Alternative Care: the same announcement said extended PCA (the waiver add-on) could not be used after September 30, 2026, and that people on Alternative Care can no longer use PCA and use CFSS instead.

One item is not settled. The 2026 legislature amended the CFSS statute (Minn. Stat. 256B.85, subdivisions 7 and 7b) and added subdivisions 7c to 7g. Those subdivisions include the rules on paid spouses and parents. The statute page lists the amendments, but we did not find their effective dates or a plain statement of what they change. Until DHS publishes guidance, treat the limits described on this page as the current rules and check with DHS before relying on them for a new arrangement.

Minnesota self-direction sources

• Minnesota DHS: Consumer Directed Community Supports (CDCS) Policy Manual
• Minnesota DHS: CDCS policy on paying a spouse or parent of a minor
• Minnesota DHS: Financial management services (FMS) providers
• Minnesota DHS: Community First Services and Supports (CFSS)
• Minnesota DHS: CFSS questions and answers
• Minnesota Statutes 256B.85: Community First Services and Supports
• Minnesota DHS: Transition from PCA and CSG to CFSS
• Minnesota DHS: Electronic visit verification
• HHAeXchange: Minnesota information hub

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)
• Minnesota EVV requirements

Other states with a choice of FMS vendors

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