Self-Direction allows for people receiving OPWDD Medicaid waiver services to have more control and flexibility on how they receive their services and supports. You must be eligible and enrolled in the OPWDD HCBS Medicaid waiver to be able to get Self-Direction.
There are two different types of Self-Direction:
- Employer authority where you work with a agency to hire and supervise the staff that support you.
- Budget authority where you work with a broker to create a budget of Medicaid dollars to spend on services. You and your broker work with a fiscal intermediary to bill and pay for goods and services.
Most people choose to have budget authority.
How does a Self-Direction budget work?
OPWDD decides the amount of money that you have in your budget. This amount is a Personal Resource Account.
Find a broker and work together to create a Self-Direction budget. Use this budget to decide what types of services you would like to receive. You can pay for broker services through your Self-Direction budget. You submit your budget to a fiscal intermediary and to DDRO for approval.
If you live in OPWDD certified housing, then you can only use your budget to pay for services during the day outside of your home. This is an “Other than Residential” budget type.
How does getting staff work under Self-Direction?
There are three models, described below with examples.
Agency Supported
- You are responsible for hiring, training and managing agency staff
- The agency decides how much to pay the staff person and what their benefits will be.
Example: Joe has employer authority. He works with his local ARC agency to find and hire a Community Habilitation staff worker to help him learn how to take public transportation.
Self-Hired
- You have a budget and can decide how much to pay the staff person.
Example: Charlene has been struggling to get a job. She decides to hire a job coach who specializes in working with people who are neurodivergent to help her with her resume and with applying to jobs.
Direct Provider Purchased
- You buy specific services from an agency.
- The agency sets salaries and manages staff.
- People who would like a mix of Self-Direction services and more traditional agency services use this method.
Example: Dylan has Self-Direction with budget authority but would like to continue to attend the Group Day Habilitation where they have been going to three times per week for the past three years. They work with their broker and the agency to continue these services and pay for them through their Self-Direction budget.
How do I decide if Self-Direction is right for me?
We recommend talking to your care manager and anyone else that helps you make decisions such as family members, friends and staff. You may also want to think about some of the positives and negatives of Self-Direction listed below.
Positives
- You have more flexibility and choice about how you spend your day.
- You can tailor your services to suit your interests and preferences.
- You can access services that are not otherwise available through OPWDD Medicaid waiver.
Negatives
- It can take a long time to start Self-Direction.
- You might have to pay for services or items out of pocket and wait to be reimbursed.
- It can be hard work to manage a budget and hire and train staff.
