Self-Direction and FMS in New Jersey

All states: self-direction map

New Jersey self-direction at a glance

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

Which Medicaid programs in New Jersey offer self-direction?

New Jersey offers Medicaid self-direction in three programs: the Personal Preference Program (PPP) for personal care, and two programs for adults with intellectual and developmental disabilities, the Supports Program and the Community Care Program. Two different state divisions run them, and the rules are not the same. In all three, the participant has employer authority and budget authority.

• Personal Preference Program (PPP): the self-directed alternative to the NJ FamilyCare (Medicaid) Personal Care Assistant benefit. It serves members of any age who are approved for Personal Care Assistant services, need them for at least six months, and can direct their own care or have an authorized representative. The Division of Medical Assistance and Health Services (DMAHS) runs it, and the member's managed care organization assesses, counsels and enrolls. The participant has employer authority and budget authority, in the form of a monthly cash grant spent under a Cash Management Plan.
• DDD Supports Program, self-directed services: serves adults 21 and older with an intellectual or developmental disability who are Medicaid eligible and meet the functional criteria of the Division of Developmental Disabilities (DDD). There is no waiting list. DDD runs it under the state's section 1115 demonstration. The individual has employer authority and budget authority.
• DDD Community Care Program, self-directed services: serves adults 21 and older with an intellectual or developmental disability who meet an institutional level of care and specific Medicaid income and resource criteria. Entry is from a waiting list or when a person is at imminent risk of homelessness. DDD runs it under the same section 1115 demonstration. The individual has employer authority and budget authority.

Employer authority means the participant recruits, hires, schedules and supervises the workers. Budget authority means the participant also decides how a set amount of money is used. DDD's self-direction page says self-direction is available through both of its Medicaid programs, with the same two models, the same vendors and the same list of services.

In the DDD programs, services a self-directed employee can provide are Community Based Supports, Individual Supports (hourly), Interpreter Services, Respite, Supports Brokerage and Transportation. The budget can also pay community vendors for items such as Assistive Technology, Environmental Modifications, Goods and Services, Natural Supports Training and Vehicle Modifications. In PPP, the state's 2026 program overview explains that the budget is built from the authorized personal care hours and a rate of $20.40 an hour (as of January 1, 2026). The program holds back 12.5 percent for employer costs, and the remaining 87.5 percent is the monthly cash grant.

Who handles financial management services (FMS) in New Jersey?

Four organizations handle financial management services in New Jersey, and which one a person uses depends on the program. In the DDD programs it is Acumen or Easterseals NJ, depending on the model the individual picks. In the Personal Preference Program it is Palco for Horizon NJ Health members and Public Partnerships LLC (PPL) for members of every other health plan. New Jersey calls these organizations fiscal intermediaries.

A fiscal intermediary handles the paperwork side of employing a worker: enrolling workers, processing time, running payroll and filing employer taxes. New Jersey uses two models, and the difference is who the legal employer is.

• Vendor Fiscal/Employer Agent (VF/EA), DDD programs: the vendor is Acumen. The individual, or a family member or friend they choose, enrolls as the employer of record and holds the federal employer ID number (EIN). Acumen handles payroll and taxes as the employer's agent. The state pays the monthly fee and workers' compensation.
• Agency with Choice (AWC), DDD programs: the vendor is Easterseals NJ. Easterseals NJ is the employer of record, and the individual is the managing employer who picks and directs the workers. The added fee and workers' compensation come out of the individual's budget.
• Personal Preference Program: the participant is the employer of record and holds the EIN. The fiscal intermediary handles payroll, taxes, workers' compensation and payments under the Cash Management Plan. The state's 2026 overview lists Palco for Horizon NJ Health and PPL for Aetna Better Health of New Jersey, Aetna Assure Premier Plus (D-SNP), Fidelis Care, UnitedHealthcare Community Plan and Wellpoint.

Do participants choose? In the DDD programs the individual chooses between the two models, which also decides the vendor, and uses one model at a time. DDD's side-by-side comparison lays out the differences. A person who has no self-directed employee and only wants community vendor services must use VF/EA. In PPP, each managed care organization selects its own fiscal intermediary, so the vendor follows from the member's health plan.

Both vendor lineups are recent. DDD moved its VF/EA work from PPL to Acumen, with the final go-live on December 7, 2025. PPP changed in 2025 from one statewide fiscal intermediary to one picked by each health plan, and Horizon NJ Health moved to Palco with the first Palco pay period starting November 1, 2025.

A person can have both PPP personal care and DDD self-directed employee services, but cannot use one EIN for both. DDD's models FAQ says only the person receiving services can be the PPP employer of record, so that person must use Agency with Choice or name someone else as the VF/EA employer on the DDD side.

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

Family members can be paid in all three programs, but the rules differ. DDD says that in either of its models a family member can be hired, including a parent, spouse or guardian. PPP participants can hire friends, relatives or neighbors who are at least 18 and authorized to work in the United States, but the authorized representative cannot be the paid worker.

• DDD Supports Program and Community Care Program: a parent, spouse or guardian can be hired. Every self-directed employee must meet the same requirements, whatever the relationship or living arrangement: fingerprinting and background checks, drug testing, a child abuse record (CARI) check, mandated training, CPR and First Aid, daily service notes, and EVV unless exempt.
• PPP, adult participants: friends, relatives and neighbors can be hired. An authorized representative cannot work for the participant or be paid for the representative role. A PPP participant cannot be a paid worker for another participant.
• PPP, child participants: a parent may be the paid worker for their child. In that case a separate authorized representative, who is not the paid worker, must manage the program for the child.

Pay and hours have limits. PPP participants set the wage between the state minimum wage ($15.92 in 2026) and $25 an hour. The state's general PPP FAQ says a single caregiver cannot be authorized for more than 40 hours a week, so a second worker must be hired for hours beyond that. In the DDD programs the individual chooses the hourly wage within DDD's "reasonable and customary" limits and the budget.

DDD's standing policy is also that one self-directed employee cannot provide more than 40 hours a week for an individual. A temporary allowance from 2020 permits overtime for emergent, unanticipated circumstances. In a November 2025 update, DDD said the live-in exemption from premium overtime pay is not available under Acumen, Easterseals NJ or PPP. Any self-directed employee who works more than 40 hours in a week is paid time and one half, family and live-in workers included.

Does EVV apply to self-directed workers in New Jersey?

Yes. Electronic visit verification (EVV) applies to self-directed workers in New Jersey, and each worker uses the EVV tool of their fiscal intermediary. Live-in caregivers can be exempt if the exemption paperwork is kept current. We did not find a primary source that says a worker's pay is withheld when a shift has no EVV record.

• DDD, Vendor Fiscal/Employer Agent: DDD lists EVV, unless exempted, as a requirement for all self-directed employees. Acumen employees use Acumen DCI for in-home Community Based Supports, Individual Supports and Respite. DDD's September 2025 EVV webinar says the mobile app is preferred and a phone option is available.
• DDD, Agency with Choice: Easterseals NJ employees use EVV through HHAeXchange. The latest state document we found that names HHAeXchange for this group is a July 2023 newsletter, so confirm the current tool with Easterseals NJ.
• Personal Preference Program: workers use their fiscal intermediary's tool. For PPL that is the Time4Care app with the BetterOnline portal. For Palco it is Palco's EVV and its Connect portal.
• Live-in caregivers: in PPP, live-in caregivers are exempt from EVV, and the participant must complete the exemption documentation and keep it current. In the DDD programs, live-in caregivers can be exempt with an annual attestation.

On pay, the sources stop short of a firm rule. No state or vendor document we read says that a shift without an EVV record goes unpaid, in DDD or in PPP. If this matters for your payroll or your household, ask the fiscal intermediary directly (Acumen, Easterseals NJ, PPL or Palco).

What is changing next for self-direction in New Jersey?

As of the last check, we did not find an upcoming change to New Jersey self-direction with a set date. The two large vendor changes, DDD's move to Acumen and Horizon NJ Health's move to Palco, are already in effect. Two items remain open and could change later.

• More PPP health plans may change fiscal intermediary. The state's fiscal intermediary transition FAQ (August 2025) says Aetna, Fidelis Care, UnitedHealthcare and Wellpoint may move to a new PPP fiscal intermediary later, after a state-approved readiness review. No plan or date has been announced, and PPL serves those plans today.
• DDD's overtime allowance is under review. In November 2025 DDD said its temporary overtime allowance for self-directed employees, and its funding of the half-time premium, remain under review, with no compliance deadline issued. We did not find a later decision.

Because both items are open, check the Personal Preference Program page and DDD's self-direction page for updates before you rely on either point.

New Jersey self-direction sources

• NJ Division of Developmental Disabilities: Self-Direction
• NJ DDD: Self-directed employee models FAQ (February 2026)
• NJ DDD: Self-directed employee models side by side
• NJ DDD: Update webinar, November 26, 2025
• NJ DDD: Acumen EVV and service documentation webinar (September 2025)
• NJ DMAHS: Personal Preference Program
• NJ DMAHS: Personal Preference Program overview (2026)
• NJ DMAHS: General PPP FAQ (April 2024)
• NJ DMAHS: PPP Fiscal Intermediary Transition FAQ, Version 2 (August 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)
• New Jersey 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.