Self-Direction and FMS in Washington
All states: self-direction map
In short: One statewide Consumer Directed Employer, Consumer Direct Care Network Washington, is legal employer of individual providers; clients are managing employers.
Washington self-direction at a glance
| Self-directed programs | Community First Choice, Medicaid Personal Care, New Freedom, and respite in four DDA waivers |
|---|---|
| FMS model | Agency with choice (co-employment) through a Consumer Directed Employer |
| FMS vendors | One statewide Consumer Directed Employer: Consumer Direct Care Network Washington (CDWA). New Freedom also uses ACES$ for goods and services payments. |
| Who is the employer | CDWA is the legal employer. The client is the managing employer. |
| Can family be paid | Yes, with limits. Not a spouse (with narrow exceptions), not a parent of a client under 18, and not a foster parent for a child in their licensed home. |
| EVV for self-directed workers | Partly. Individual providers who do not live with the client clock in and out with CareAttend. Live-in providers are exempt. |
| Budget authority | Yes in New Freedom (seven counties). Not confirmed for the other programs. |
Last verified against state sources: 2026-10-13.
Which Medicaid programs in Washington offer self-direction?
Washington offers self-direction mainly through the individual provider option. An individual provider (IP) is a caregiver the client picks and manages, instead of a worker sent by a home care agency. IPs deliver personal care under Community First Choice and Medicaid Personal Care, personal care under New Freedom, and respite under four developmental disabilities waivers. Only New Freedom also gives the participant a budget to manage.
- Community First Choice (CFC) personal care by an individual provider: a 1915(k) state plan option that serves Medicaid clients of any age who meet the functional and financial rules. That includes older adults and adults with disabilities served through Home and Community Services, and children and people with developmental disabilities served through the Developmental Disabilities Administration (DDA). It is run by the Department of Social and Health Services (DSHS), with Area Agencies on Aging providing case management. DSHS describes CFC personal care as delivered at home by an agency or by an individual provider the client chooses. The client has employer authority. We did not find a state document that says whether CFC includes budget authority.
- Medicaid Personal Care (MPC) personal care by an individual provider: state plan personal care for Medicaid clients who need help in their own home. It is run by DSHS. State rules list individual providers among the in-home providers for this program. The client has employer authority. We did not find a state statement on budget authority.
- New Freedom (New Freedom Consumer Directed Services): a 1915(c) waiver that serves adults 65 and older, or 18 and older and blind or with a disability, who need a nursing facility level of care and live in their own home. It is offered in seven counties: King, Pierce, Spokane, Whitman, Stevens, Pend Oreille and Ferry. DSHS runs it through Home and Community Services, with care consultants from the Area Agencies on Aging. The participant has both employer authority and budget authority, using a monthly budget and a spending plan.
- DDA waiver respite by an individual provider: respite is available in four 1915(c) waivers for children and adults with developmental disabilities: Basic Plus, Core, Individual and Family Services, and Children's Intensive In-home Behavioral Supports. DDA runs them. State rules list the Consumer Directed Employer among the qualified respite providers, so a family can use an individual provider it selects. The client has employer authority for that worker. We did not find whether the state treats any of these waivers as having budget authority.
Employer authority means the client selects, schedules, supervises and can dismiss the worker. Budget authority means the client also manages a set amount of money. Personal care for DDA clients is paid under Community First Choice, not under the DDA waivers.
A note on names: DSHS has reorganized, and its aging and developmental disabilities administrations are now the Home and Community Living Administration. Many DSHS pages still use the name DDA, so this page does too. The New Freedom waiver was renewed by the federal government for January 1, 2025 through December 31, 2029, and the renewal added the five counties outside King and Pierce.
Who handles financial management services (FMS) in Washington?
One company handles payroll and employer duties for individual providers across Washington: Consumer Direct Care Network Washington (CDWA). Washington does not use a classic fiscal intermediary that only processes payroll for a participant who is the employer. Instead, the state contracts with a Consumer Directed Employer (CDE), which is the legal employer of the workers, while the client stays the managing employer. CDWA calls this an Agency with Choice model.
In plain words, the job is split in two. CDWA hires the individual provider on paper, runs payroll and handles the administration. The client decides who the worker is and directs the daily work. DSHS says clients, as managing employers, select, schedule, manage and dismiss their IP.
- Legal employer: the Consumer Directed Employer. State law (RCW 74.39A.500) makes the CDE the legal employer of the individual providers it co-employs, and keeps the consumer's right to select, dismiss, assign hours to and supervise the worker.
- How many vendors: the law calls for one Consumer Directed Employer, and up to two only if a single qualified vendor cannot be found. DSHS names CDWA as the contracted vendor. Because there is one CDE, clients do not pick among FMS vendors. The choice a client makes is between an individual provider through CDWA and a home care agency.
- Vendor by program: CDWA is the legal employer of individual providers in Community First Choice, Medicaid Personal Care, New Freedom personal care and DDA waiver respite.
- New Freedom has a second vendor: personal care in New Freedom is bought from a CDWA individual provider or a contracted home care agency. The other goods and services in the participant's spending plan are paid by a separate financial management service, ACES$ Financial Management Services. ACES$ describes itself as the goods and services payments provider for the program and publishes a 2026 pay schedule.
The rate the state pays the CDE is not set by the vendor alone. A 14 member Consumer Directed Employer Rate Setting Board, created in state law, meets every even-numbered year to propose the rate. The rate has two parts: an administrative part and a labor part for individual providers. Individual providers are represented by the union SEIU 775, and CDWA advertises starting pay of 23.54 to 27.28 dollars an hour with benefits.
Who can be a paid caregiver under self-direction in Washington?
Clients can hire family, friends and neighbors as individual providers, but Washington rules out a few close relationships. The Consumer Directed Employer must reject the client's spouse, a natural, step or adoptive parent of a client who is 17 or younger, and a foster parent caring for a child in their licensed foster home. Adult children, siblings, other relatives and parents of adult clients are not on that list for personal care.
Important: Parents cannot be paid individual providers for their own children under 18. A bill that would let DSHS ask for federal approval to pay parents of minor children with developmental disabilities (SB 5211) has not passed, so the rule stands.
- Personal care through the CDE (Community First Choice and Medicaid Personal Care): the rule is WAC 388-115-0540. The spouse bar has exceptions only for chore services, Veteran Directed Home Care and WA Cares clients. CDWA's hiring page repeats the rule: a spouse typically cannot be an IP, and parents cannot be IPs for their own children under 18.
- DDA waiver services: under WAC 388-845-0111, a spouse cannot be paid for any waiver service, and a parent or legal representative cannot be paid for a client under 18. A parent of an adult client can be paid only for transportation, for respite when the parent lives in a separate home, or for residential habilitation as a certified agency.
- New Freedom: the participant handbook says the paid caregiver cannot be the participant's spouse, legal guardian or New Freedom authorized representative. The program rule also bars a designated representative from being the paid provider.
Hours are limited too. Individual providers have a default work week limit of 40 paid service hours. Some long-standing providers have a higher limit, and the state can approve exceptions for a specific client. When the law requires overtime, it is paid at one and a half times the regular rate.
Does EVV apply to self-directed workers in Washington?
Partly. Electronic visit verification (EVV) applies to individual providers who do not live with the client. They clock in and out with CDWA's CareAttend, using the mobile app, an EVV landline or a fob. Individual providers who live with the client are exempt from EVV.
- Whose system: individual providers use the system their employer, CDWA, provides. The DSHS EVV page says IPs who do not live with the client must use CareAttend.
- Live-in exemption: live-in IPs are exempt from EVV and can record their time in DirectMyCare.
- Claims depend on it: ProviderOne, the state's Medicaid payment system, denies claims that are missing required EVV elements. The state's EVV requirement guide applies these denials to Consumer Directed Employer claims as well as agency claims, phased in on January 1, April 1 and July 1, 2026. Claims for live-in IPs are exempt.
- Respite: DDA waiver respite delivered by a CDWA individual provider follows the same CareAttend rules, with the same live-in exemption.
Two points could not be confirmed. The New Freedom sources we read do not mention EVV, so we did not find a program-specific statement, although New Freedom individual providers are CDWA employees. We also did not find a statement on whether a worker's own paycheck is held when a shift is missing EVV data. The denial rule is written about the claim CDWA submits to the state. For either question, ask CDWA at 866-214-9899 or DSHS at CDE@dshs.wa.gov.
What is changing next for self-direction in Washington?
We did not find a confirmed upcoming change to self-direction in Washington as of the last check on October 13, 2026. The Consumer Directed Employer setup, the paid family rules and the EVV rules described above are all in effect now. A few items are worth watching, and none of them has a firm date.
- Login security at CDWA: DSHS says CDWA will require multi-factor authentication on all its systems starting in fall 2026. No exact date has been published, and we could not confirm that it has started. Ask CDWA how it affects your login.
- Paying parents of minor children: SB 5211 (companion HB 1200) would let DSHS seek federal approval to pay parents who provide personal care to their minor children with developmental disabilities. It has not passed. It was reintroduced on January 12, 2026 and remains in the Senate Ways and Means Committee.
- WA Cares rules: DSHS filed a notice on February 3, 2026 saying it is considering new rules on financial management services vendors for the WA Cares program. No rule text or effective date has been given. WA Cares is a state long-term care insurance benefit, not Medicaid, but it uses the same managing employer and legal employer split through CDWA.
We did not find an end date for the state's contract with CDWA or any plan to rebid it. If that matters to your planning, ask DSHS at CDE@dshs.wa.gov.
Get notified when Washington self-direction rules change
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Who to ask about self-direction in Washington
Questions about self-direction in Washington are best put to the state. Start with DSHS: Consumer Directed Employer. Published contact: DSHS: CDE@dshs.wa.gov. Consumer Direct Care Network Washington: InfoCDWA@ConsumerDirectCare.com, 866-214-9899.
Washington self-direction sources
- Washington DSHS: Consumer Directed Employer
- Washington State Legislature: RCW 74.39A.500 (Consumer Directed Employer program)
- Consumer Direct Care Network Washington: Consumer Directed Employer
- Washington State Legislature: WAC 388-115-0540 (who cannot be an individual provider)
- Washington State Legislature: WAC 388-845-0111 (limits on paying family for DDA waiver services)
- Washington DSHS: Electronic Visit Verification
- Washington Health Care Authority: EVV systems requirement guide
- Washington DSHS: New Freedom waiver
- ACES$ Financial Management Services: Washington
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)
- Washington EVV requirements
Other states with one statewide FMS vendor
Arkansas, Connecticut, District of Columbia, Indiana, Iowa, New Mexico, North Dakota, Oklahoma, South Carolina, Tennessee, Vermont, West Virginia, Wyoming. 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.
