There are some services you can only get if you have Self-Direction with budget authority and have a fiscal intermediary.
These services are:
- Individual Directed Goods and Services (IDGS)
- Live-in Caregiver (LIC)
- Support Brokerage Services
- Community Transition Services (CTS)
- Other Than Personal Services (OTPS)
- Housing Subsidy
- Any self-hired staff for Community Habilitation (CH), Supported Employment (SEMP), and/or Respite
Keep reading to learn more.
Individual Goods and Services (IDGS)
Individual Goods and Services are only available to Self-Direction participants with budget authority. IDGS items and services must meet the following requirements:
- It must be a item or service that is not already provided by the HCBS waiver or New York State Medicaid.
- It must be related to a need or goal in the self-directing participant’s Life Plan.
- It must increase independence or replace assistance from a staff person.
- It does not interfere with the participant’s health and safety.
- It is provided to and for the benefit of the participant.
Examples of Individual Goods and Services are:
Community Classes
This allows people with developmental disabilities to use their self-direction budget to purchase classes that are open to the public so they can participate in their community. The class content cannot duplicate or replace any Medicaid or waiver service and the subject must relate to the self-directing person’s goals.
For more information please see the article “What are community classes?”
Transportation
IDGS can be used to reimburse gas mileage, or pay for public transportation when the participant is traveling to and from a service that is part of their Self-Direction budget. If transportation is built into the program or activity cost then it cannot be reimbursed. Transportation that is paid for by self-hired staff is also not reimbursed.
Camp
IDGS may fund camp programs. Reimbursement from Medicaid is not available until after a person has attended the camp. Waiver funded respite camp is categorized as ‘Respite’ in the budget. Camps outside of New York State are not reimbursable under IDGS.
Paid Neighbor
Pay a neighbor to serve as an “on-call” to help you when needed. They should live no more than 30 minutes away. A paid neighbor cannot be a family member.
Staffing Support
This is funding to pay for staff to help with organization and other administrative tasks. These tasks cannot be a broker or fiscal intermediary’s tasks.
Gym and Activity Memberships
Membership must be for a single individual and in the name of the person who is self-directing. Family memberships are not reimbursable. Common examples of reimbursable memberships include: gym or health club, museum, zoo, sports leagues, and scouts.
Live-in Caregiver (LIC)
Self-Direction participants can use their budget to pay someone to live with them to help support their physical, social, or emotional needs so that they can live safely and successfully in their own home. A live-in caregiver cannot be a family member or relative.
Other than Personal Services (OTPS)
Other than Personal Services is $3,000 in state funding in a person’s Self-Direction budget that may pay for items and services that Medicaid does not fund.
- Services must increase the participant’s independence and/or health and safety.
- Services must be related to an outcome in the person’s Life Plan.
- OTPS is only available to adults.
