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Medicaid Self-Directed Services

Federal Medicaid authorities allowing beneficiaries to self-direct their home and community-based services, including hiring their own caregivers (including family members). Authorized under Section 1915(j) self-directed personal assistance services and Section 1915(k) Community First Choice option.

Allows Medicaid beneficiaries to direct their own care services. Participants receive an individual budget to hire, manage, and dismiss their own care workers -- including family members in most states. Two main federal authorities: Section 1915(j) for self-directed personal assistance services under existing waivers, and Section 1915(k) Community First Choice providing a 6% FMAP increase to participating states. Per KFF 2025 survey: 49 states (all except Alaska) allow self-direction. All states with self-directed programs allow enrollees to select, train, and dismiss workers. 41 states allow enrollees to set worker pay rates. 39 states allow budget allocation authority. All 50 responding states pay family caregivers through at least one program. 10 states have implemented 1915(k) CFC: CA, CT, DC, MD, MN, MT, NY, OR, TX, WA. Self-direction most common in IDD waivers (41 states) and elderly/physical disability waivers (39 states). See data/inventory/hcbs-waivers-by-state.json for complete state-by-state inventory.

Some details for this program are still being verified. Check the official source for the most current information.

Eligibility

  • U.S. citizenship or qualified immigrant status required
  • Care recipient must have a qualifying disability or need for assistance
  • Must be Medicaid-eligible

Services

Allows Medicaid beneficiaries to direct their own care services. Participants receive an individual budget to hire, manage, and dismiss their own care workers -- including family members in most states. Two main federal authorities: Section 1915(j) for self-directed personal assistance services under existing waivers, and Section 1915(k) Community First Choice providing a 6% FMAP increase to participating states. Per KFF 2025 survey: 49 states (all except Alaska) allow self-direction. All states with self-directed programs allow enrollees to select, train, and dismiss workers. 41 states allow enrollees to set worker pay rates. 39 states allow budget allocation authority. All 50 responding states pay family caregivers through at least one program. 10 states have implemented 1915(k) CFC: CA, CT, DC, MD, MN, MT, NY, OR, TX, WA. Self-direction most common in IDD waivers (41 states) and elderly/physical disability waivers (39 states). See data/inventory/hcbs-waivers-by-state.json for complete state-by-state inventory.

How to apply

Apply online or find more information at the official program page.

  • medicaid (depends_on): Must be Medicaid-eligible
  • hcbs-waivers (companion): Self-direction is available within 1915(c) HCBS waivers or as standalone 1915(j)/(k)