This session discussed findings on self-directed home- and community-based services (HCBS) from interviews with federal and state officials, national subject matter experts, financial management services (FMS) agencies, information and assistance supports entities, managed care plans, beneficiary advocacy organizations and an Area Agency on Aging.
These findings are organized into two sets of considerations: state design and state administration. Among state design considerations, staff identified the following flexibilities for states developing a self-direction program: the HCBS authorities available for self-direction, the populations served, the services offered, considerations for budget and employer authority, and the role of family caregivers. The findings on considerations for how states administer self-direction focused on variation and collaboration across state agencies, collaboration across entities to provide information and assistance supports, including the different roles they play, the role of FMS agencies, and quality reporting, monitoring, and oversight strategies.
