Self-Direction and FMS in Nevada

All states: self-direction map

Nevada self-direction at a glance

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

Which Medicaid programs in Nevada offer self-direction?

Nevada offers self-direction in two places: State Plan Personal Care Services and the Home and Community Based Services Waiver for Persons with Physical Disabilities (the PD waiver). The state calls its main option the Self-Directed service delivery model, and it runs through an Intermediary Service Organization (ISO). The PD waiver also has a second option, added in 2025, that gives the recipient a budget to manage through a Financial Management Services (FMS) vendor. We did not find a self-directed option in the Frail Elderly waiver or the Intellectual and Developmental Disabilities waiver.

• State Plan Personal Care Services, Self-Directed model (including Self-Directed Skilled Services): serves Medicaid and Nevada Check Up recipients of any age who need help with daily living and who can manage their own care or have a Personal Care Representative do it for them. It does not cover people living in institutions. It is run by Nevada Medicaid (the Nevada Health Authority, formerly the Division of Health Care Financing and Policy). The recipient has employer authority but not budget authority. The recipient decides how the weekly authorized hours are used, but does not set wages or control a budget. Skilled services are capped by level, up to 40 hours a week. The rules are in Medicaid Services Manual Chapter 2600.
• PD waiver, self-directed through an ISO: serves people with a physical disability who meet nursing facility level of care. Nevada Medicaid administers the waiver and the Aging and Disability Services Division (ADSD) operates it. The state manual labels this option Employer Authority. The recipient has employer authority but not budget authority. It covers four waiver services: Attendant Care, Chore, Homemaker and Respite.
• PD waiver, self-directed through Financial Management Services (FMS): serves PD waiver recipients who choose to direct those same four services with a budget. Nevada Medicaid administers it, ADSD operates it, and case managers refer recipients to the FMS vendor. The recipient has both employer authority and budget authority. The rules are in Medicaid Services Manual Chapter 2300.

Employer authority means the recipient recruits, selects, schedules, trains, directs and dismisses the worker. Budget authority means the recipient also manages the money for the service, including the worker's pay rate within limits. In the PD waiver the case manager offers the choice between the ISO and FMS options. The PD waiver has a set number of slots and a wait list. A recipient using the State Plan Self-Directed model can switch to the provider agency model at any time.

Who handles financial management services (FMS) in Nevada?

It depends on the model. In the ISO model, an Intermediary Service Organization is the employer of record for the worker, and the recipient chooses among the ISOs enrolled with Nevada Medicaid. In the PD waiver's FMS option, the recipient is the employer and a single FMS vendor acts as a fiscal/employer agent. Acumen's own Nevada material says Acumen is that vendor. We did not find a state page that names it.

An Intermediary Service Organization is an agency that employs the personal care assistant on paper while the recipient runs the day to day work. The ISO is the employer of record, and the recipient (or a Personal Care Representative) is the managing employer. Other states call this kind of arrangement agency with choice, though Nevada does not use that phrase. A fiscal/employer agent is different. It handles payroll and employer taxes on the recipient's behalf, and the recipient stays the legal employer.

• ISO model (State Plan personal care, Self-Directed Skilled Services and the PD waiver ISO option): ISOs enroll with Nevada Medicaid as Provider Type 83, and must be certified or licensed by the Division of Public and Behavioral Health. The state pays the ISO a contracted rate. ISOs must follow the direct care worker wage requirements in the State Plan and their enrollment contract, and the Nevada Medicaid Audit Unit audits payroll records.
• Choosing an ISO: the recipient chooses. To start, the recipient contacts the local Nevada Medicaid District Office or ADSD office, which supplies the list of enrolled ISOs. The state's ISO page says to contact the District Office for enrolled ISOs. We did not find a public list.
• FMS model (PD waiver only): the recipient hires, trains, supervises and terminates workers and sets wages within limits. The FMS vendor runs payroll and taxes and helps with a spending plan. Nevada told tribes in a July 2024 letter that it had procured an FMS vendor that performs all Fiscal/Employer Agent functions under Internal Revenue Code Section 3504. The letter does not name the vendor.
• The FMS vendor: Acumen's Nevada PD waiver FAQ (dated February 2025) says Acumen went live on March 1, 2025, and that its fee is paid outside the participant's service budget. With one vendor, there is no choice among FMS vendors, but the recipient can still choose the ISO option instead.

In the FMS option the recipient sets pay up to the Medicaid waiver service rate, less employer taxes and costs as calculated by the FMS vendor, and no lower than the minimum wage. Prior authorizations are approved for the year with a weekly frequency. The FMS vendor tells the employer and the case manager when use runs 10 percent or more over or under.

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

Relatives who are not legally responsible for the recipient can be paid in every self-directed option. The rule for legally responsible individuals depends on the program. For State Plan self-directed personal care and skilled services they cannot be paid. In the PD waiver they can be paid for four services.

• State Plan Personal Care Services and Self-Directed Skilled Services: legally responsible individuals may not be reimbursed. State Plan personal care is not authorized at all when a legally responsible individual is available and capable of providing the care, and one who is unavailable or incapable must supply verification. Other relatives can be paid as the ISO's employee.
• Personal Care Representative: a representative who directs care for the recipient cannot be the paid personal care assistant, and is not paid for the representative role.
• PD waiver (ISO or FMS): legally responsible individuals may be paid for Attendant Care, Homemaker, Respite and Chore services if the recipient chooses them. They can work as an employee of a provider agency or ISO, or enroll through the FMS vendor. A legally responsible individual who lives with the recipient is limited to two hours a week of paid homemaker services. Paying a legally responsible individual also triggers extra case manager visits, at least twice a year in person and quarterly by phone.
• PD waiver FMS option: Acumen's FAQ says employers may hire anyone they choose, including a spouse or family member. The worker must be at least 18, pass a background check, have a National Provider Identifier (NPI), be able to use an EVV option, and not be the recipient's Designated Representative.

On pay and hours in the FMS option, Acumen's FAQ says workers must be paid at least $16.00 an hour and are paid every two weeks. It also says they may not work more than 40 hours a week unless a live-in or kinship exemption form is on file, in which case the extra hours are paid at the regular rate. Nevada Medicaid's 2023 fact sheet on family caregivers lists who can be paid by program, but it was written before the FMS option existed.

Does EVV apply to self-directed workers in Nevada?

Yes. Electronic visit verification (EVV) applies in both self-directed models. In the ISO model the worker records each visit in the ISO's approved EVV system and the recipient confirms the visit. In the PD waiver FMS option, Acumen says workers clock in and out in its DCI mobile app and that it cannot accept paper timesheets.

• ISO model: ISOs must use an EVV system that meets the 21st Century Cures Act. That can be the state's Sandata system or another system that sends visits to the Sandata Aggregator. Every personal care assistant must document services in an approved EVV system. The recipient must agree to use EVV and confirm each visit electronically, or by voice if a phone system is used.
• PD waiver services: Attendant Care, Homemaker, Respite and Chore must be documented in an approved EVV system, and the recipient confirms each visit. Legally responsible individuals who are paid under the waiver must use EVV to check in and out.
• PD waiver FMS option: the state manual says FMS employers who do not follow EVV requirements may be terminated from FMS self-direction. Acumen's FAQ says workers clock in and out within a 76 meter geofence of the participant's home, and that Nevada requires at least 90 percent EVV compliance. We did not find that 90 percent figure in a state document.
• Does pay depend on it: ISOs must submit initial personal care claims through an EVV system. Since April 2026, though, Nevada's fee-for-service system treats EVV visit-match errors as informational, not as denials, according to Web Announcement 3891.

Some points could not be confirmed. We did not find a published EVV exemption for live-in caregivers in Chapter 2600 or Chapter 2300, and Acumen's FAQ does not mention one, but the state's EVV addendum was not part of this review. We also did not find how self-direction or EVV is arranged for recipients in managed care plans. For either question, ask the Nevada Medicaid District Office, the recipient's ISO, or the FMS vendor.

What is changing next for self-direction in Nevada?

As of our last check on October 13, 2026, we did not find an upcoming change to self-direction in Nevada. The most recent changes are already in effect. Recheck the state manual chapters before relying on this page for a decision.

• July 1, 2026: Nevada revised Medicaid Services Manual Chapter 2600. All language on the Personal Care Services Independent Contractor model was removed as obsolete, and providers may now send initial authorization requests directly to the state's review vendor. See Web Announcement 3968.
• April 1, 2025: Chapter 2300 was revised to add Financial Management Services as a new self-directed model in the PD waiver, matching the waiver amendment the federal government approved on December 3, 2024. See Web Announcement 3641.
• ISO option: Acumen's FAQ says the ISO option in the PD waiver is not being phased out.

We did not find a published end date for the FMS vendor contract or any notice of a new procurement. To confirm the current vendor and contract term, ask Nevada Medicaid or ADSD.

Nevada self-direction sources

• Nevada Medicaid Services Manual Chapter 2600: Intermediary Service Organization (effective July 1, 2026)
• Nevada Medicaid Services Manual Chapter 2300: Physical Disabilities waiver (effective April 1, 2025)
• Nevada Medicaid: Intermediary Services Organization (ISO)
• Nevada Medicaid: Tribal notification letter on the PD waiver amendment (July 2024)
• Nevada Medicaid: FAQ for in-home services by family caregivers (November 2023)
• Nevada Medicaid: Web Announcement 3968 (Chapter 2600 revision)
• Nevada Medicaid: Web Announcement 3891 (EVV claim edits)
• Nevada Medicaid: Web Announcement 3641 (Chapter 2300 revision adding FMS)
• Acumen: Nevada PD Waiver FAQs (February 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)
• Nevada 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.