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Self-directed Medicaid services offer participants, or their representatives if applicable, decision-making authority over certain services and direct responsibility to manage their services with the assistance of a system of available supports. While self-directed service option requirements and opportunities may vary from state to state, in general this service delivery model is an alternative to traditionally delivered and managed services. Self-direction of services allows participants to have the responsibility for managing all aspects of service delivery in a person-centered planning process, and includes the option of working with a service provider.

The National Center on Self-Directed Services has a long history of working with states to create budget authority and employer authority for individuals with disabilities and their families to achieve the greatest level of personal autonomy possible.

Self Direction is available in most states for people with disabilities who choose an active role in developing an individualized approach to an array of supports; managing the resources that fund their services to whatever extent they choose; and hire, fire, and train the staff who work with them to the extent they choose.