Understanding Self-Directed Care in Pennsylvania: A Guide to Participant-Directed Services

Want to learn more live? Join our free virtual webinar, “Getting Started with PDS: Pennsylvania Participant Direction Services,” on Wednesday, September 30, 2026, from 11:00 AM to 12:00 PM ET.

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Participant-Directed Services (PDS) is Pennsylvania’s term for self-directed care. It lets you choose your own caregiver, set your own schedule, and control how your care happens, instead of relying on an agency to make those decisions for you. 

In a traditional home care agency, the agency assigns your caregiver. You may not meet that person until their first day. If they call out sick, the agency sends someone new, often a stranger. 

Still confused? Learn the difference between self-directed vs. agency home care.

Under PDS, you make these decisions yourself. You become what’s called a Common Law Employer, or CLE. This means you are legally the employer of the person who provides your care. As a CLE, you can: 

• Choose who provides your care, including a friend, a family member, or another trusted person 
• Set a schedule that fits your life 
• Decide how your day-to-day care is carried out 

Becoming an employer usually means handling payroll, taxes, and paperwork. PPL removes that burden. As your Financial Management Services (FMS) provider, PPL manages payroll, tax filings, and enrollment paperwork on your behalf, so you can focus on your care. 

PDS gives you the final say over who cares for you and how that care works. Many people choose a caregiver who already understands their routine and needs, which can make daily care more consistent and comfortable. 

PDS serves a wide range of people across Pennsylvania. You don’t need one specific diagnosis to qualify. What matters most is that you need ongoing help to stay safely at home, and that you qualify for Medicaid. 

PDS is available to children and adults. It covers people with intellectual disabilities, autism, physical disabilities, chronic illness, brain injuries, and spinal cord injuries, along with older adults who need support to keep living at home. 

Which program fits you depends on your specific needs. In Pennsylvania, these services are split between two state offices: 

• The Office of Developmental Programs (ODP) serves people with intellectual disabilities, autism, and related developmental disabilities. 
• The Office of Long-Term Living (OLTL) serves older adults and adults with physical disabilities, chronic illness, brain injuries, or spinal cord injuries. 

A Supports Coordinator or Service Coordinator can help you figure out which program matches your situation before you apply. The next section breaks down each office and its programs.

PPL supports PDS through two state offices in Pennsylvania, each running its own Medicaid programs. These are the programs PPL supports as a Participant-Directed Services provider. Both offices let you direct your own care, but the specific rules and paperwork differ depending on which one you’re in. 

ODP supports people with intellectual disabilities, autism, and related developmental disabilities. It offers three programs with participant direction: 

• Person/Family Directed Support (P/FDS) Waiver: Open to people of any age with an intellectual disability or autism. Also open to children under 9 with a developmental disability likely to lead to one of these diagnoses, and to people under 22 with a developmental disability caused by a medically complex condition. 
• Community Living Waiver: Uses the same eligibility rules as the P/FDS Waiver. 
• Consolidated Waiver: Also uses the same eligibility rules. Unlike the other two waivers, it does not have a set spending limit per person. 

If you’re on any of these three waivers, you can choose to direct your own services.

What’s a waiver? A Medicaid waiver is a program that allows the state to offer services beyond what standard Medicaid usually covers, like long-term care at home instead of in a nursing facility. Waivers let eligible people receive care in their own homes and communities rather than an institutional setting.

OLTL supports older adults and adults with physical disabilities, chronic illness, brain injuries, or spinal cord injuries. It offers two programs with participant direction: 

• OBRA Waiver: Supports adults with physical disabilities, chronic illness, brain injuries, or spinal cord injuries who need help to remain safely at home. 

• Act 150 Program: A state-funded program, not paid for by Medicaid, that offers similar support for adults with physical disabilities, without the same income limits tied to Medicaid waivers. 

If you’re enrolled in either program, you can choose participant direction as your service model.

Not sure which program applies to you? That’s exactly what we’ll cover at our free webinar, “Getting Started with PDS: Pennsylvania Participant Direction Services,” on September 30.

Register Here

When you choose participant direction, you become your caregiver’s employer. That’s a big responsibility. As an employer, you’re suddenly on the hook for things like running payroll, paying employment taxes, and handling enrollment paperwork, on top of managing your actual care. 

This is where a Financial Management Services, or FMS, provider comes in. An FMS provider handles the employer-side paperwork and finances for you, so you can focus on your care instead of running payroll like a small business owner. 

PPL serves as the FMS provider for the Pennsylvania programs covered in this article. Specifically, PPL acts as what’s called a Vendor Fiscal/Employer Agent, or VF/EA. In plain terms, that means PPL legally handles the tax and payroll responsibilities that come with being an employer, while you keep the authority to choose, direct, and manage your own caregiver. 

As your FMS provider, PPL: 

• Processes your caregiver’s paycheck using your approved budget 
• Handles federal, state, and local employment taxes on your behalf 
• Supports you and your caregiver through enrollment and paperwork 
• Provides customer service when you have questions 
• Gives you reports so you always know what’s been paid and when 

Working with an FMS provider isn’t optional. It’s a required part of participant direction in Pennsylvania. The good news is that once it’s in place, most of the employer-side work happens in the background, so your day-to-day focus can stay on your care and your caregiver, not on tax forms.

The services you receive through PDS depend on your specific care plan. Every plan is built around your needs, so what one person receives may look different from what another person receives. 

These services generally fall under what’s called Long-Term Services and Supports, or LTSS. LTSS covers the ongoing help someone may need with everyday activities, medical needs, or both, in order to stay safely at home instead of moving into a nursing facility or other care setting. 

A big part of LTSS is personal care, which covers hands-on help with daily activities like: 

• Bathing and dressing 
• Cooking and meal preparation 
• Light housekeeping 
• Reminders or help with taking medication 

Depending on your needs, your caregiver may also help with more hands-on medical tasks, such as wound care or catheter care. Whether these tasks are included depends on your specific care plan and the program you’re enrolled in, so it’s worth talking to your Supports Coordinator or Service Coordinator about exactly what your caregiver is able to help with. 

Both ODP and OLTL follow a similar process to build your plan. You’ll work with a Supports Coordinator (SC) or Service Coordinator to figure out what kind of help you need and how much support your program can cover. From there, you take an active role in managing your services: 

• Choosing, hiring, and if needed, letting go of your own caregiver 
• Setting and adjusting your caregiver’s schedule 
• Reviewing and approving your caregiver’s timesheets 
• Keeping track of your budget and how much you’ve spent 

To help you manage all of this, PPL provides two online tools, depending on which program you’re in: 

• MyAccount, used for ODP programs 
• BetterOnline™, used for OLTL programs 

Both tools let you handle enrollment paperwork, monitor your budget, and manage timesheets from your computer or phone. 

Timesheets themselves are tracked through Electronic Visit Verification, or EVV. This is a system that confirms when your caregiver clocks in and out for a shift. Pennsylvania requires EVV for these programs, and PPL uses an app called Time4Care™ to handle it. If your caregiver doesn’t have a smartphone or tablet, a landline option is also available once it’s set up through PPL’s customer service. 

One of the biggest benefits of PDS is choosing who actually shows up to help you. Under both ODP and OLTL, you can hire people you already know and trust, rather than accepting whoever an agency sends. 

Depending on your program, this person is called a Support Service Professional (SSP) under ODP, or a Direct Care Worker (DCW) under OLTL. Either way, they work directly for you. 

You can generally hire: 

• A family member 
• A friend 
• Another trusted person who meets your program’s requirements 

The person you hire still has to meet certain standards, like completing required paperwork and any needed background checks. Your Supports Coordinator or Service Coordinator can walk you through exactly what’s required for your program. 

Spousal caregivers work differently depending on your program. Whether a spouse can be paid to provide your care depends entirely on whether you’re enrolled in ODP or OLTL: 

• Under ODP, spouses can be paid caregivers. This applies to the Consolidated Waiver, Community Living Waiver, and P/FDS Waiver, for services like In-Home and Community Services (IHCS) and Companion services. 
• Under OLTL, spouses cannot be paid caregivers. This rule applies to the OBRA Waiver and Act 150 Program. 

If you’re not sure which rule applies to you, your Supports Coordinator or Service Coordinator can confirm what’s allowed based on your specific program. 

Want to go deeper? Learn how you can pay a caregiver through Medicaid — including everything on rules, waivers, and what to expect.

Reading about PDS is a good first step, but sometimes it helps to ask your questions out loud and hear directly from people who know the programs inside and out. 

That’s exactly what our upcoming webinar is for. 

“Getting Started with PDS: Pennsylvania Participant Direction Services Webinar” 

📅 Wednesday, September 30, 2026 
🕚 11:00 AM – 12:00 PM ET 
💻 Virtual, free to attend 

This webinar is designed for families, caregivers, and individuals who want to learn more about participant direction in Pennsylvania. You’ll learn how these programs work, who they’re for, and what steps to take to get started, with time for your questions. 

Whether you’re just starting to explore PDS or you’re ready to begin the enrollment process, this is a great opportunity to get clear answers before you move forward. 

Register Here

Getting started with PDS begins with a referral. You don’t need to already be enrolled in Medicaid to begin the process. 

If you’re interested in ODP programs (Person/Family Directed Support Waiver, Community Living Waiver, or Consolidated Waiver): 

Reach out to your Supports Coordinator and ask them to submit a referral. If your Supports Coordinator needs help submitting the referral, they can contact PPL Customer Service at 1-800-249-0861 or email PAODP-CS@pplfirst.com. 

If you’re interested in OLTL programs (OBRA Waiver or Act 150 Program): 

Reach out to your Service Coordinator and ask them to submit a referral. If your Service Coordinator needs help submitting the referral, they can contact PPL Customer Service at 1-877-908-1750 or email cs-oltl@pplfirst.com. 

If you’re not currently on a waiver program and want to learn more about whether you might qualify, reach out to PPL’s Concierge Team at learn@pplfirst.com. 

Once your referral is submitted, a coordinator will work with you to determine your eligibility and build a care plan based on your needs. If you choose participant direction, PPL will help you and your caregiver complete enrollment so you can get started. 

Public Partnerships, LLC (PPL) is a Financial Management Services provider, and self-directed care is what we do. We believe people deserve real choice over who cares for them, and we’ve spent years building the tools and support that make that possible. Today, we support more than 50 self-directed programs across the country, with over 700,000 participant and caregiver relationships and more than $10 billion in goods and services payments processed. In Pennsylvania, we work with participants and caregivers across programs run by the Office of Developmental Programs and the Office of Long-Term Living, handling the paperwork, payroll, and taxes that come with being an employer, so you don’t have to figure it out alone. 

Getting started with participant direction can feel overwhelming, and that’s okay. We’re here to walk you through every form, every deadline, and every question along the way. From your first referral to your caregiver’s first paycheck, our team is ready to help. 

Live in a different state, or just curious how self-direction works elsewhere? PPL supports 50 programs across 18 states nationwide.

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