Frequently Asked Questions

Potentially. It depends on the specific program you are enrolling into, but most do allow you to hire a family member or friend as your caregiver. Check out our program info for your state.

There are several options for Medicaid enrollees to self-direct their Medicaid services under a state plan and waiver programs. States will pay them with financial aid from the Self-Directed Medicaid Services program, if they qualify. Visit our list to find out if we’re partnered with a program in your state.

Medicaid law prohibits direct payments to self-directing program participants, so states—or managed care organizations (MCOs) working on their behalf—must appoint a financial management service (FMS) company, like PPL, to help participants balance budgets and supply all required reports.

We also help you become your caregiver’s employer. We’ll run background checks, help with required paperwork to get them hired, pay them, and take out taxes. In some programs we can get you paid for services like transportation, and home modifications. Your monthly budget is based on your needs and set by the state or MCO.

It’s an alternative to using a healthcare agency that lets you decide who provides your caregiving and when.

Healthcare agencies employ caregivers who care for you in your home. You can’t choose who is providing your care, and you’ll often have several different people coming to your home.

Self-direction is called “person-centered” care. Your care begins and ends with your needs, not what’s convenient or profitable for an agency.

Nothing! Self-direction, participant-direction, consumer-direction are just different names for the same thing. It can vary depending on the state and program.

If you are eligible for Medicaid, and there is a self-directed home care program in your state, you might qualify.

Medicaid eligibility varies by state, so take our questionnaire to see if you can enroll in a self-directed care program.

Self-direction may not be for everyone, but we’ll help you decide on the best option. Check out 10 reasons why self-directed care could be right for you or a loved one, and if you have questions, get in touch.

If you have a case manager, you can also talk to them about your options.

In some programs you are given a budget and decide how to spend it. There are some restrictions, obviously, but the money can be used for things like personal care support, transportation, home modifications, physical therapy, community classes, skills training, and so on. Exactly how you can use the money is based on your needs, and the specific rules and limitations of your program.

Self-direction is generally cheaper than agency care and gives you more value for money.
Have a look at our comparison of long-term care options, showing the savings.

In general, you can hire friends, neighbors, or other people you choose to provide care – and in some states you can also hire family members. States have age requirements, and each program has different rules about who you can hire. You can find details for the programs we work with.

You can find phone numbers for all of the programs we work with on our contact page.

Unfortunately, no. Self-direction is for people who need long-term care, and Medicare doesn’t pay for long-term services.

If you have Medicare AND Medicaid, you are what’s called “dually eligible” and you might be able to self-direct some of your Medicaid services. To find out if you would be eligible, take our questionnaire.

Under self-direction you, or your representative, are the employer of your caregivers. You hire, train, manage and, if needed, dismiss them (hopefully not)! If this sounds like a lot, don’t worry, we’ve got your back, every step of the way.

• Reviewing job applications, interviewing, checking references, hiring, and deciding tasks and schedules.
• Doing background checks, if required (we’ll do this for you).
• Teaching your employees about your needs.
• Treating your employees with dignity and respect.
• Reviewing and approving timesheets accurately and promptly.
• Providing feedback on job performance.
• Disciplining and firing when necessary.
• Determining the hourly wage, in some states.

No, not at all. You are not earning an income as the employer so as far as your other benefits are concerned, nothing has changed.

Yes, you are in charge of making sure that your needs are met, and scheduling your worker is part of that responsibility. A big part of self-direction is making sure you are supported in all situations. You and your case manager will develop a backup plan in case your worker gets ill and is unable to work.

If your worker doesn’t show up or is unable to provide services and your health and welfare are jeopardized, then you will activate your back-up plan, so that you get the services and support you need. Your case manager will help you develop your backup plan when you talk about your service plan. Make sure you have a backup plan before you need it!

Your worker’s pay comes out of your monthly budget or authorized hours. We’ll manage all the paperwork so you can focus on your care.

When you approve a timesheet, we pay your caregiver based on the agreed hourly rate and the number of hours they have worked. The hours and pay rate are pre-set by the program or laid out in your budget.

In most states, workers can either get a direct deposit into their bank account, or a pre-paid credit card. Some states also allow workers to get paper checks by mail.

A representative can be:

• a legal representative, like a court-appointed guardian, a parent of a child, or a spouse
• a family member or friend chosen by you to speak on your behalf.

A representative can help you make decisions, review and approve timesheets, and complete other tasks. They can be a family member or friend who is willing to check in on you regularly and join you when you meet with program staff. You can find details for the programs we work with.

Yes. In every state, direct caregivers must have some training, but the type and amount of training depends on the program. You can either train your worker yourself or they can get outside training to help them to support you.

Most programs require you to check the background of the person you intend to hire. Some let you decide whether to hire someone with select types of criminal history. You usually cannot hire anyone who has committed a serious crime or is on a domestic abuse register. Every program has its own requirements. We run background checks for you when you want to hire someone.

In some states, you are responsible for paying for background checks and fingerprinting. If you are in one of those states, the cost would come out of your budget. In other states, Medicaid or the managed care plan working on their behalf pays.

Hourly wages differ from state to state and from program to program. In some programs, the state sets the wages, in others you decide their pay rate. Workers are your employees; we’ll send them a W-2 on your behalf so they can file their taxes (which will be withheld from their paycheck).

It’s an alternative to using a healthcare agency that lets people decide who provides their care and when.

Self-direction is called “person-centered” care. It’s all about the participant’s needs, not what’s convenient or profitable for an agency.

Nothing! Self-direction, participant-direction, consumer-direction are just different names for the same thing. It can vary depending on the state and program.

Potentially. It depends on the specific program they are enrolled in, but most allow you to be hired as a caregiver to a family member or friend. Check out our program info for your state.

There are several options for Medicaid enrollees to self-direct their Medicaid services under a state plan and waiver programs. States will pay them with financial aid from the Self-Directed Medicaid Services program, if they qualify. Visit our list to find out if we’re partnered with a program in your state.

Medicaid law prohibits direct payments to self-directing program participants, so states—or Managed Care Organizations (MCOs) working on their behalf—must appoint a Financial Management Service (FMS) company, like PPL, to help participants balance budgets and supply all required reports.

We also help the participant become your employer. We’ll run background checks on you if required, help with paperwork, pay you, and take out taxes.

Since late 2016, EVV has been required by law for all Home and Community Based Services (HCBS) programs, which includes almost all those we work with (full list here). We have a super easy-to-use app called Time4Care that works on iOS and Android phones and tablets. People love it.

The only time your location is logged is the moment when you clock in or clock out. NO other time, ever.

More info.

The number of hours you can work in a month is decided by the program and is based on the participant’s needs. In some programs, caregivers are authorized to work overtime hours and will be paid for that overtime in accordance with state and federal law.  However, please note that you may never work more than your authorized hours. 

You can find phone numbers for all of the programs we work with on our contact page.

We get this question a lot, but we don’t hire caregivers, we only help people to hire their own.

If you want to help us in our mission to make self-direction easy for anyone who wants it, great! Take a look at our open jobs.

For the purposes of self-direction, the participant (your friend or family member) becomes your employer. They will hire and train you, and determine your hours.

Your pay comes out of the participant’s monthly budget or authorized hours.

You’ll submit timesheets to the participant, and when they approve it, we’ll pay you based on the agreed hourly rate and the number of hours you worked. The hours and pay rate are pre-set by the program or laid out in their budget.

In most states, you can either get a direct deposit into your bank account, or a pre-paid credit card. Some states also allow you to get paper checks by mail.

Yes. In every state, direct caregivers must have some training. But the type and amount of training depends on the program. You will either receive training from the participant of from an outside training organization.

Most programs require this. Some let the participant choose to hire you if you have criminal history, but usually not if you’ve committed a serious crime or are on a domestic abuse register. Every program has their own requirements. We run background checks for the participant during the hiring process.

Hourly wages differ from state to state and from program to program. In some programs, the state sets the wages, in others the participant decides your pay rate. As an employee; we’ll send you a W-2 on the participant’s behalf so you can file your taxes (which will be withheld from your pay).

It’s an alternative to using a healthcare agency that lets people decide who provides their care and when.

Self-direction is called “person-centered” care. It’s all about the participant’s needs, not what’s convenient or profitable for an agency.

We are a Financial Management Services company who ensure that program participants understand their roles and responsibilities, and provide assistance when needed.

Self-direction is generally cheaper than agency care and gives your program and the participants more value for money.

Have a look at our comparison of long-term care options, showing the savings.