Self-Direction of Home- and Community-Based Services:
A Training Curriculum for Case Managers

The ability to direct and manage their own services and supports is important to many individuals who need the home- and community-based services (HCBS) provided through state Medicaid programs. These self-directed models may also be known as "consumer direction" and "participant direction" when referring to specific states' programs. In these models, individuals direct many or all of their own HCBS, including selecting and managing direct service workers and/or managing a budget (known in some states as a service cost maximum) for needed services. Self-direction allows individuals to determine what mix of personal care services and supports works best for them within the parameters of their person-centered service plan.

As a service delivery model, self-direction has long been part of states’ Medicaid fee-for-service programs and has resulted in improved quality and satisfaction with care. Now many states implementing Medicaid managed long-term services and supports (MLTSS) or other managed integrated care programs that provide HCBS are incorporating self-direction into these arrangements.

Self-direction is a major paradigm shift in the way publicly funded HCBS are delivered by health plans. Along with this shift in thinking comes a change in the roles and responsibilities of case managers. The Integrated Care Resource Center, with support from the former National Resource Center for Participant-Directed Services, developed a webinar-based training curriculum on self-direction for health plan case managers.

The webinars and accompanying resources in the curriculum provide an overview of self-direction, considerations for the design and implementation of a self-direction program, and best practices for oversight of a self-direction program in a managed care context. The curriculum also provides several tools to help case managers explain the self-direction option and the related responsibilities of individuals choosing this option. In addition, there is information for health plans about helping individuals to determine if the self-direction option is right for them.

The training is divided into four modules:

Module 1: Introduction to Self-Direction

Module 2: Implementing Self-Direction

Module 3: Implementing Self-Direction in a Managed Care Context: Special Considerations

Module 4: Operating and Managing Self-Direction in a Managed Care Context

Additional Resources

  • Frequently Asked Questions about Self-Direction This document answers common questions about self-direction including: (1) what is self-direction and why is it an important option for individuals receiving HCBS; (2) what are the components of self-direction. The document also defines self-direction terminology. It is intended to be used by case managers and other involved in self direction implementation.
  • Roles and Responsibilities in a Self-Direction Program This tool gives examples of the roles and responsibilities of the individual, representative, case manager, information and assistance function, the financial management services function, and the direct care worker.
  • Four Steps for Managed Care Plans to Promote Person-Centered Planning in Self-Direction Models (Integrated Care Resource Center/June 2017) This tip sheet suggests steps that managed care plans can take to ensure that case managers are effectively trained on approaches to promote person-centered planning in self-directed delivery models for home- and community-based services.
  • Tips for States to Advance Person-Centered Planning in Self-Direction Models (Integrated Care Resource Center/June 2017) This tip sheet offers suggestions for states operating managed long-term services and supports programs or other managed integrated care programs to: (1) understand the person-centered planning process; (2) establish robust contract requirements and policy guidance that support person-centered self-direction models; and (3) assess managed care plans’ person-centered planning practices in self-directed models.