Self-Direction by State

Where is self-direction changing next?

These are the changes states have announced or scheduled that affect self-direction itself: FMS vendors and procurements, who can be paid, hours, wages and timekeeping. Dates come from the state. Where no date has been published, we say so.

With a date

• Colorado, January 1, 2027: The weekly cap on paid hours for one caregiver drops from 84 to 70 hours on January 1, 2027, and to 56 hours on July 1, 2027.
• Illinois, January 1, 2027: The Home Services Program Personal Assistant rate is scheduled to rise to $20.75 an hour on January 1, 2027, or on federal approval if later.
• Hawaii, July 20, 2027: The exception that lets QUEST Integration health plans pay self-directed workers up to 15 days after a pay period ends expires July 20, 2027 unless renewed.
• Texas, September 1, 2027: The share of visits that can be recorded with an alternative device drops from 50 to 25 percent on September 1, 2027. This applies to CDS employers too.
• Minnesota, September 30, 2027: People still on PCA or the Consumer Support Grant must move to CFSS by September 30, 2027, after which both programs end.

Announced, no date yet

• Alabama: A proposed Community Waiver Program amendment would cut the self-direction FMS agencies from two to one. Comment closed September 15, 2026; no effective date is published.
• Alaska: The state has said it will remove the 40 hour weekly limit on legally responsible individuals paid under Community First Choice. No date is set.
• Iowa: Iowa plans two new age-based HOME waivers that keep the Consumer Choices Option and add more approved FMS providers. CMS approval is pending and no start date is announced.
• Kentucky: Oversight of Participant Directed Services is moving from the aging department to each waiver's operating agency, with the transition anticipated by January 1, 2027.
• Maryland: A waiver amendment still under CMS review would change self-directed budgets and add a weekly cap on paid family caregivers. It is not approved yet.
• Missouri: The state's procurement for fiscal management services for DD Self-Directed Supports has not concluded. The Acumen contract was extended in the meantime.
• Ohio: Under Senate Bill 315 the state anticipates rule changes in July 2027 that require GPS capture for visits and narrow the live-in caregiver exemption.
• Pennsylvania: The state plans waiver and regulation changes on relative caregiver hours in participant-directed services, with public comment anticipated in January 2027.
• South Carolina: The state has started a procurement for its FMS contract because the current one is expiring. No vendor or date has been published.
• Tennessee: TennCare lists a procurement for its single statewide fiscal employer agent contract, projected for release in the second quarter of 2027.
• Vermont: ARIS plans to move several self-directed programs to a new timekeeping platform. The July 2026 start was postponed and no new date is published.
• Virginia: The state has said EVV compliance penalties for consumer-directed attendants will not start before January 1, 2027. The penalty terms are not published.
• Wisconsin: The state intends to move IRIS from three fiscal employer agents to one, with transfers in 2027. The award is under protest and not final.

How does self-direction compare across states?

One row for each state and Washington DC. Filter the table to find the states that share a setup, and click a state for its programs, vendors and sources.

Swipe sideways to see every column.

How do states set up self-direction?

Self-direction (also called participant direction or consumer direction) lets a person on Medicaid home and community-based services, or their representative, choose and manage their own workers. States build it into different programs: waivers for older adults, for people with physical disabilities, and for people with intellectual and developmental disabilities, as well as state plan personal care. One state can have several self-directed programs, each run by a different agency with its own rules.

What is the difference between employer authority and budget authority?

Employer authority means the participant recruits, hires, schedules and supervises workers. Budget authority goes further: the participant also controls a budget and decides how to spend it within program rules, often including what to pay workers. Some programs offer both, and many offer employer authority only, with hours authorized by a case manager.

Who handles payroll and taxes?

A Financial Management Services (FMS) provider does, in most states. In the fiscal/employer agent model the participant is the legal employer and the FMS provider is their agent. In agency with choice, an agency is the legal employer and the participant directs the work. A few states skip the outside vendor and pay workers through a state payroll system. States also differ on whether participants get one assigned vendor, a choice of several, or a different vendor for each program or health plan.

How current is this information?

Each state summary is checked against primary sources such as the state Medicaid agency, its aging and disability departments, CMS, and the state's contracted FMS vendors, and each state page shows the date it was last verified. This page is a reference, not legal advice, so confirm details with your state before you act on them.

Frequently asked questions about self-direction by state

Related reading

• Understanding Self-Direction and FMS
• Self-Direction Fiscal Intermediary: A Guide for Participant-Directed Care
• Self-Direction vs. Self-Determination: Why the Words We Choose Shape the Care We Deliver
• Fiscal Intermediary Software: What Every FMS Needs
• Why Do Self-Directed Participants Choose Your FMS as Their Fiscal Intermediary?
• Medicaid Home Care by State: EVV requirements map

Ankota provides software for financial management services organizations and the agencies that support self-direction. If you want to talk through how your state's program works, contact Ankota.