Self-direction helps people of all ages, with all types of disabilities, maintain their independence at home and in their communities by giving them the authority to choose the services and supports that work best for them.

The self-direction model is an increasingly popular option for individuals wanting more control over their healthcare. Since 2016, self-direction has grown at about twice the rate of traditional home and community-based services (HCBS). According to a recent survey conducted by HHAeXchange, 35% of providers are planning to grow their agency in 2022 by expanding to self-direction.

For providers just getting started with this care model, recruiting a well-rounded team of professionals who know the subject matter and can work efficiently both independently and as a group can be challenging. The complex roles in self-direction, and the fact that states and programs may use different names to identify those roles, only further complicate the process.

However, putting the time and effort into hiring qualified staff will make a world of difference on your future success and net margin. We’re here to offer tips to help you streamline your recruitment practices and guide you on the path to building your self-direction dream team.

Financial Management Services (FMS)

FMS entities support participants by performing administrative tasks such as payments, taxes, employment, and insurance regulatory compliance, so participants can focus on managing their services and supports.

In the early years of self-direction, few options for FMS providers existed. Now that FMS has been a service for over 25 years, there are many professionals that can fit within your strategic plan. Recruiting an established, trusted individual with a local, state, federal, and industry-wide network can launch your company to the head of the line.

FMS Subject Matter Experts to consider recruiting include:

  • FMS Director
  • Intake & Enrollment Specialist
  • Quality Assurance Specialist
  • Tax Specialist or Accountant
  • Payroll and Billing Manager
  • Consumer Outreach Specialist
  • Information Technology (IT) Director

Your agency may need additional FMS resources, depending on if your model is Agency with Choice (AwC) or Fiscal Employer agent (F/EA).


Self-direction is built on the belief that the individuals receiving the services and supports know their needs best and are in the best position to plan and manage their own services. Therefore, the most important member of a self-direction team is the Participant*. Every other team member should keep the Participant’s wants and needs as the primary focus.

Participants can and should be engaged every step of the way – when you first design your program, and as you grow and improve your operations. Here are a few steps providers can take to ensure participants’ continuous engagement:

  • Meet and brainstorm with individuals to design goals and implement services based on their individual needs
  • Offer live customer service representatives; expand customer service hours to include nights and weekends
  • Request feedback through focus groups, ongoing stakeholder engagement meetings, and other communication methods that all participants can utilize

Additional Players in the Circle of Supports

In addition to FMS entities, there are other key players on a self-direction team who should meet regularly with the Participant to discuss ideas, set goals, and ensure the care plan is carried out successfully. Some states have both Care Managers and Support Brokers, while others assign all the tasks of providing information and assistance into one role.

Care Manager

The Care Manager* is the liaison between the Participant’s individual wants and needs and the expansive world of services. Their primary role is to listen to the participant’s needs and help identify which people and services are best suited to meet them.

A Care Manager, as defined in the State Medicaid waiver, may be hired to:

  • Assess the participant’s documentation and record that the individual has re-certified for Medicaid coverage annually
  • Create a person-centered individual service plan and adjust as needed
  • Ensure that services are of acceptable quality and are appropriate to the needs of individual participants; avoid duplication of other formal services
  • Acknowledge and respect the participant’s right to be treated with consideration and dignity
  • Make service decisions utilizing a multi-disciplinary team approach based on comprehensive, ongoing assessments which include input from the participant and the participant’s primary caregiver
  • Provide a well-defined, viable, and accessible point of entry for long-term care services

Essentially, Care Managers help participants find and connect to the appropriate services and benefits and assist with keeping those services and benefits up to date. They ensure that the participant is satisfied with their services and help them make changes as necessary.

Support Broker

The Support Broker assists the participant in developing and carrying out their care plan. Occasionally, this role may also be referred to as Counselor, Coach, Information and Assistance Specialist, or Consultant.

Support Brokers are critical to ensuring the participant’s overall knowledge of the program, and facilitating the administrative tasks that accompany self-direction, such as:

  • Assisting in completing employer-related paperwork
  • Developing effective recruiting and hiring techniques for the participant’s workers
  • Providing or arranging training for the participant’s workers
  • Setting schedules and implementing back-up plans for staffing emergencies
  • Outlining proper protocols and procedures for termination of workers
  • Reviewing workplace safety issues and strategies for effective management of workplace injury prevention
  • Identifying and communicating any proposed modifications to the participant’s service plan
  • Advising and assisting with the development of procedures to monitor expenditures and utilization of services
  • Complying with the standards, regulations, policies, and waiver requirements related to self-direction

The Support Broker’s role is not to manage the self-direction process but to facilitate the tasks that ensure its success. The ideal Support Broker is a natural problem solver who follows a personalized approach to program development.


Technology is the conduit that allows all the players on a self-direction team to communicate and stay connected. Finding software that gives each party access to up-to-the minute information so they can effectively plan and manage care services keeps the Participant in the driver’s seat and other partners informed of program changes.

Integrated and configurable software that can accommodate the intricacies of FMS is critical to a program’s success. When evaluating potential solutions, look for technology that enables the following:

  • Efficient tracking, managing, and storage of participant budget information
  • Electronic signatures to ease onboarding
  • Real-time access to communication and spending information
  • Quick and accurate Medicaid claims processing
  • Purpose-built EVV solutions that track only at clock-in and clock-out and not for the duration of the service
  • Built-in workflows that know the state-specific program rules

Identifying a software partner who can help you stay ahead of compliance regulations while facilitating effective communication among your team is key.


It is important to recognize that all team members should operate with the same goal: to provide the best possible services and opportunities for participants. Brainstorming ideas and presenting different opinions in self-direction program management or decision-making are key to delivering quality services and solutions.

Implementing technology that enables participants to maintain choice, flexibility, and control over their services, while establishing visibility and connection among FMS Entities, Care Managers, and Support Brokers can streamline processes and make day-to-day management simple. Learn more about the difference the right technology can make.

Note: The term “participant” is synonymous with individual, consumer, resident, or client. The term “care manager” is synonymous with service coordinator, case manager, counselor, or support coordinator.