Medicaid home- and community-based services (HCBS) are designed to allow people with long-term services and supports (LTSS) needs to live in their homes or a home-like setting in the community. Self-direction is an HCBS delivery model that allows the individual choice in their service provider(s) and control over the amount, duration, and scope of services and supports in their person-centered service plan. Self-direction models are available in all 50 states and the District of Columbia, and over 1.5 million individuals self-directed their HCBS through programs funded primarily by Medicaid in 2023.
In this session, MACPAC staff presented an overview of self-direction for HCBS, including information on the statutory framework, design considerations, enrollment data, and outcome evaluations. Commissioners discussed areas of interest regarding self-directed HCBS, and highlighted priority issues to address in subsequent stakeholder interviews with state and federal officials, third party entities, and consumer advocates.