Self-Direction and FMS in Rhode Island

All states: self-direction map

Rhode Island self-direction at a glance

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

Which Medicaid programs in Rhode Island offer self-direction?

Rhode Island has two main self-directed programs. Personal Choice is run by the Executive Office of Health and Human Services (EOHHS), the state Medicaid agency, for older adults and adults with disabilities. Self-Directed Supports is run by the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) for adults with intellectual and developmental disabilities. In both, the participant is the employer of the workers and also manages a budget.

• Personal Choice Program: serves adults 18 to 64 with disabilities and people 65 and older who qualify for Medicaid long-term services and supports at a high or highest level of care and live at home. EOHHS runs it under the state's Section 1115 demonstration waiver, and the state rule that governs it is titled Self-Directed Care. The participant has both employer authority and budget authority. EOHHS sets a monthly budget from the person's assessed need, and goods and services are capped at 10 percent of that budget.
• Self-Directed Supports: serves adults with intellectual and developmental disabilities who are eligible for developmental disability services. The BHDDH Division of Developmental Disabilities runs it. The participant has both employer authority and budget authority. The package includes fiscal intermediary services, support broker services and goods and services. The EOHHS Self-Directed Care rule does not cover this program.
• Personal Choice for Neighborhood INTEGRITY for Duals members: serves people who have both Medicare and Medicaid, are enrolled in Neighborhood Health Plan of Rhode Island's INTEGRITY for Duals plan and hold an approved Personal Choice waiver from RI Medicaid. The plan covers it under EOHHS program rules, by a plan policy effective August 19, 2026. The participant has employer authority and budget authority, as in Personal Choice.
• Personal Assistance Services and Supports (PASS): serves children and youth with special health care needs who are enrolled in Medicaid. EOHHS describes it as a family-directed service delivered at home or in the community. We did not find who employs the PASS worker or whether the family controls a budget.
• The Respite Program for Children: serves children with disabilities who need an institutional level of care. EOHHS says parents or guardians find their own respite worker, with help available from certified respite agencies. We did not find who the employer of record is or how payroll is handled.

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. Rhode Island used to have a second EOHHS program called Independent Provider. The current rule, effective February 12, 2024, merged it into Personal Choice and kept the personal care aide (PCA) registry, so EOHHS now has one self-directed program. For the two children's services, the place to ask is EOHHS, through its page on Medicaid services for children and youth with special health care needs.

Who handles financial management services (FMS) in Rhode Island?

Rhode Island uses fiscal intermediaries. A fiscal intermediary (FI), which the state also calls a fiscal agent or fiscal agency, is an organization that handles payroll, taxes and workers' compensation for the participant. The participant, or a representative, stays the legal employer of the workers. The two main programs use separate sets of fiscal intermediaries, and participants choose among the approved ones.

State law defines a fiscal intermediary for self-directed personal care as a third-party organization under contract with the state that handles payroll and other employment functions for the participant.

• Legal employer: the EOHHS rule says the Personal Choice participant or representative acts as employer of record. BHDDH's Technical Bulletin 24-02 says the self-directing participant is the employer of record.
• Personal Choice: EOHHS-certified fiscal intermediaries. The fiscal agency processes PCA paperwork, runs background checks, tracks the budget and pays the workers. The same arrangement applies to Neighborhood INTEGRITY for Duals members, whose plan policy calls it a fiscal agent or fiscal advisement agency and does not name one.
• Self-Directed Supports: the participant chooses the FI. The FI processes timesheets, payroll, withholdings, employer taxes and workers' compensation, and holds a separate account for each participant's budget. A BHDDH provider list dated May 5, 2025 shows five agencies offering self-directed financial management: J. Arthur Trudeau Memorial Center, Perspectives Corporation, Refocus, Inc., The Arc of Bristol County, Inc. (doing business as Proability) and The Fogarty Center.

The BHDDH list is more than a year old, so ask BHDDH for its current fiscal intermediary contacts before relying on it (BHDDH.AskDD@bhddh.ri.gov or 401-462-3421).

Participants also set the pay rate within a state range. In Personal Choice the rule gives a PCA wage range of $15.00 to $21.00 an hour, and Neighborhood's August 2026 policy says PCAs are currently paid between $16 and $21. In Self-Directed Supports, Technical Bulletin 24-02 set a wage range of $20 to $35 an hour for direct support professionals (DSPs) as of April 30, 2024, and it does not allow bonuses.

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

Participants in both programs can hire family members, but the limits differ. Personal Choice does not allow a spouse, a financial power of attorney, a Social Security representative payee or the participant's own representative to be the paid aide. BHDDH Self-Directed Supports allows parents and guardians to be paid, with a cap on their combined weekly hours.

• Personal Choice: participants can hire friends, neighbors and family members as a personal care aide (PCA). The rule bars a PCA who is the participant's representative, spouse, financial power of attorney or Social Security representative payee, and a representative cannot be paid. The EOHHS PCA orientation from July 2025 also lists legal guardians as people who cannot be a PCA. The rule's own list does not name guardians, so a guardian who wants to be paid should confirm with Personal Choice first.
• Personal Choice hours: a PCA may work for more than one participant, but not more than 40 hours a week in total.
• Self-Directed Supports: participants may hire a parent (including adoptive parents and stepparents), a guardian, a sibling, an extended family member or a friend as a DSP. Hiring a parent or guardian requires a signed consent form.
• Self-Directed Supports hours for parents and guardians: paid parents, stepparents and guardians are limited to a combined 40 hours a week, or 60 hours when they support more than one adult child. When a parent or guardian is paid, support brokerage with quarterly in-person visits is required.
• Self-Directed Supports and live-in workers: a participant may not hire an employee who lives with them unless the Division of Developmental Disabilities approves it in advance.
• Self-Directed Supports overtime: overtime beyond 40 hours a week needs approval from the Division in advance, and the request goes through the FI.

The BHDDH rules above come from Technical Bulletin 24-02, dated April 29, 2024. We did not find paid caregiver rules for PASS or the Respite Program for Children.

Does EVV apply to self-directed workers in Rhode Island?

Partly. Electronic visit verification (EVV) applies to self-directed personal care in Rhode Island unless the worker lives with the participant. Visit data is captured when time is entered electronically and is sent on to the state. Personal Choice tells aides that their payroll is affected when hours cannot be verified.

• Personal Choice: under the rule, the participant, as employer, must complete EVV unless the PCA lives in the same household. The EOHHS PCA orientation says EVV is used to verify the PCA's hours and that payroll is affected when hours cannot be verified.
• Self-Directed Supports: EVV applies only to staff who perform 100 percent of the listed personal care tasks in the home and who do not live in the individual's home. The decision is recorded on a BHDDH self-direction EVV form. The data is captured during electronic time entry and sent to the state EVV compliance unit.
• How the data reaches the state: self-directed visits go through a dedicated third-party interface to the state's Sandata Aggregator, with completed visits sent at least daily. This is set out in an EOHHS addendum for consumer directed services that covers the BHDDH program, Personal Choice and Neighborhood.

Three points could not be confirmed. We did not find which EVV system each fiscal intermediary uses. We did not find a statement that any FI holds pay until a visit is verified. We also did not find a claims edit that covers the self-directed service codes: the fee-for-service EVV claims edit active since July 7, 2026 lists only codes T1000, S5125, S5130 and S5125 U1. For any of these, ask the participant's fiscal intermediary, or Personal Choice at 401-462-6393.

What is changing next for self-direction in Rhode Island?

We did not find a confirmed upcoming change to self-direction in Rhode Island as of the last check on October 13, 2026. One related item is in progress: EOHHS has an open procurement for a new EVV module. No award and no start date have been published.

The procurement (RFP26006663) is part of the state's replacement of its Medicaid system, a project EOHHS calls OASIS. It could change how visit data is collected or sent in the future, but we did not find a statement on how or when it would affect self-directed workers or fiscal intermediaries. Until EOHHS publishes more, the EVV rules described above stand.

Two things are worth rechecking with the state because published figures may be out of date. BHDDH updated its Self-Directed Supports page in February 2026, and the DSP wage range on this page comes from a 2024 bulletin. The BHDDH list of fiscal intermediaries dates from May 2025. Ask BHDDH for current versions of both.

Rhode Island self-direction sources

• EOHHS: Personal Choice Program
• Rhode Island Code of Regulations: 210-RICR-50-10-2, Self-Directed Care (effective February 12, 2024)
• EOHHS: PCA Orientation (July 2025)
• BHDDH: Self-Directed Supports
• BHDDH: Technical Bulletin 24-02, Self-Direction (April 29, 2024)
• BHDDH: Agency Provider List (May 5, 2025)
• BHDDH: Self-Direction EVV form
• EOHHS: Consumer directed services alternate EVV addendum, version 1.9
• Neighborhood Health Plan of Rhode Island: Clinical Medical Policy I-012, Personal Choice and Shared Living Programs

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)
• Rhode Island 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.