Self-direction is a long-term care services and supports (LTSS) delivery model that prioritizes personal choice and control. In a self-directed model, a person decides how, when, and from whom they will receive LTSS.
Federal Resources
- Self-Direction Briefing Paper Series— Compendium for policymakers and stakeholders to inform conversation and policy on home and community-based services self-direction (Centers for Medicare & Medicaid Services)
- Recruiting, Selecting, and Retaining Direct Service Workers To Provide Self-Directed Home and Community-Based Services (HCBS)— Online training provides information to people who self-direct or wish to self-direct their HCBS and others interested in finding, hiring, and retaining workers (Centers for Medicare & Medicaid Services)
- Self-Direction Options— State options under the Medicaid state plan and waivers for providing enrollees with services, and with the option to self-direct (Centers for Medicare & Medicaid Services)
- The Case for Medicaid Self-Direction: A White Paper on Research, Practice, and Policy Opportunities— History of self-directed services in the U.S. and ramifications of the growing use of Medicaid-managed care arrangements for the future of these services and supports (National Council on Disability, 2013)
Other Resources
- Using Self-Directed Services to Achieve Competitive Integrated Employment and Enhance Community Life Engagement— Brief highlights how strategies such as choosing trusted supporters, braiding funding sources, and customizing services to individual goals can advance employment and community participation (ThinkWork, 2026)
- Using Self-Directed Services to Holistically Support Employment— Brief includes real-world examples of using supports such as job coaching, transportation, and daily living assistance to support employment goals (ThinkWork, 2026)
- Planning and Budgeting for Life on Their Terms: Managing Self-Directed Services— Brief highlights strategies for overseeing budgets, hiring staff, and coordinating services to support individual goals (ThinkWork, 2026)
- Putting Self-Determination Back in Self-Direction— Spotlights self-direction in intellectual and developmental disability services through personal stories, program insights, and advocacy perspectives on autonomy and choice (Institute on Community Integration at the University of Minnesota, 2025)
- Advancing Self-Direction in LTSS: Empowering Individuals and Mitigating the Direct Care Workforce Crisis Slide Deck— Webinar on self-direction and a member discussion on ARPA implementation plans (Long-Term Quality Alliance, 2024)
- What is Self-Direction?— Article describes self-direction in long-term care service delivery, emphasizing participant choice, control, and flexibility, and includes real-life stories and videos (Applied Self-Direction, 2021)
- Taking It to the Next Level: Using Innovative Strategies to Expand Options for Self-Direction— How four states used innovative strategies to develop and expand options for self-direction and a toolkit for training, collaboration, and replication (AARP Public Policy Institute, 2018)
- “It’s Changed Everything:” Voices of Veterans in the Veteran-Directed Home and Community Based Services (HCBS) Program— Study explores the value and impact of a Veterans Affairs self-directed HCBS program on veterans’ lives in their voices (Journal of Gerontological Social Work, 2018)
- 2020 Evaluation of Experiences With Self Direction in New York State: A Focus on Sustainability— Survey results of people participating in New York State’s self-direction plan (Institute on Community Integration, 2021)
- How Can Matching Service Registries Increase Their Impact?— Article highlights an online matching service registry in Minnesota (PHI, 2019)
- Empowering Choices: Suzanne Crisp on the History of Self-Direction (YouTube)— Video podcast discusses the history of self-direction (Public Partnership, LLC, 2023)
- National Inventory of Self-Directed Long-Term Services and Supports Programs— Findings from the 2023 inventory conducted by Applied Self-Direction. Part two of the report describes the impact of national workforce shortages on self-direction and family (AARP Public Policy Institute, 2024)