Chapter 5 looks at self-direction for Medicaid home- and community-based services (HCBS). The chapter begins with a discussion of the required elements in self-direction and the key stakeholders in program administration. The chapter continues by reviewing state design considerations, including Medicaid HCBS authorities, populations served, services provided, and flexibilities for beneficiaries. Next, it describes state administrative considerations, including information and assistance supports; approaches to financial management services; and quality reporting, monitoring, and oversight. The Commission plans to continue exploring the self-direction model as a coverage option that gives beneficiaries more autonomy over their care than traditional HCBS and may help to alleviate the HCBS workforce shortage.
From: June 2025 Report to Congress on Medicaid and CHIP
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Medicaid and CHIP Payment and Access Commission