Self-Direction is a powerful choice that allows a person to maintain control over their life through a person-centered process for accessing supports and services in New York State. It is funded by federal and state Medicaid funds, and is overseen by the New York State Office for People with Developmental Disabilities (OPWDD).
Each person is unique. Self-Direction empowers people to design supports based on their unique strengths and needs. We firmly believe that Self-Direction gives the people we support and their families greater control over the services they receive, how they receive them and who provides them. Self-Direction allows people to develop a self-directed plan which supports choice as to where to live, daily activities, friends, and relationships, and how to participate in the greater community.
Below are two success stories that are a direct result of Self-Directed Services and what it has to offer:
A young man came to Citizens in 2017 looking to obtain Self-Directed Services to support him in participating in activities that he had been unable to engage in at the time. Once he met with his Circle of Support, we were able to complete his budget and hire the staff he chose, and he began to make those goals a reality. In 2021, with the help of his Self-Direction staff, he graduated with an Associate’s Degree in Computer Science. He has his driving permit and is in the process of taking driving lessons supported through his budget, so he can get his license and work to get a car of his own. He exercises every day and utilizes a personal trainer twice a week to help him work on strength training. He is looking forward to the future and has shared that he would like to work toward moving out on his own.
In 2018, a young man came to Citizens seeking support from Self-Directed Services as well as a Housing Subsidy to be able to get his own apartment. He struggled with anxiety and would at times have to leave stores, restaurants, or other public places because he would begin to have a panic attack. His father was offered a new job that would move them all to Florida. He was very upset as he didn’t want to go and was determined to stay in New York. His parents were concerned about him staying in NY independently, although he had his grandparents and other family members who offered to help. Through Self-Direction and housing, we supported him to obtain Self-Directed Services and to hire his best friend (a family friend) for Community Habilitation. His friend supported him through the process of obtaining his driver’s license and an apartment. His friend also agreed to be his ‘paid neighbor’ to be available to him at any time he felt the need, in an emergency, etc. His family chipped in and bought him his own car. With support, he began to shop for himself, make and follow up on doctor’s appointments, and maintain his apartment as independently as he could, while utilizing the supports that have been set up for him. He met a girl and started to date her and is still with her today. Here we are two years later, he is living his best life and is thrilled to have been given this chance. He helps out his grandparents with work around their house and has taken a few trips with his girlfriend to Florida to visit his parents.
Who is eligible for Self-Directed Services?
Anyone who is eligible for OPWDD services and enrolled in the Home and Community Based Services (HCBS) Waiver can choose to self-direct their services. Self-direction may be right for a person if they can make their own decisions (or have help to) and if they want more flexible supports and services.
How does Self-Direction work?
A person can choose if they want an agency to help them to self-direct (agency-supported self-direction) or if they would like to manage their own budget and staff with help from a Fiscal Intermediary and Support Broker (Self-Direction with Budget and Employer Authority). Self-Direction allows people the opportunity to hire their own support staff. FI and Broker Services are necessary to pursue Self-Direction.
Self-Direction gives a person the chance to make decisions about supports and services that help them to:
- Enjoy meaningful relationships with family and friends
- Experience health and growth
- Live in the home and community they choose
- Work, volunteer or do activities they enjoy
- Enhancing community integration and social capital is at the core of self-direction
How is my SD budget determined?
When a person chooses to Self-Direct, their needs will be assessed using the Developmental Disabilities Profile (DDP-2). It can be done by their Care Manager, Broker, FI or an OPWDD Front Door staff. This assessment is also used to determine their maximum budget amount, also known as the Personal Resource Allocation (PRA). They will work with their Support Broker to develop a complete Self-Direction Budget that includes the supports and services they identified during Person-Centered Planning. Their Broker will also develop Habilitation Plans for any self-directed services that they choose to hire their own staff to work with them on.
What is a Broker?
A Support Broker helps a person exercise as much choice and control over their life as possible. The Support Broker guides someone through initiation of a self-directed budget and provides ongoing support. The Support Broker works with a person who self-directs to: Build their Circle of Support team; Plan a budget for their services; Educate on services and community resources; Provide training and support on hiring and supervising staff; Develop habilitation plans, when needed; and Communicate with the Fiscal Intermediary.
What is a Fiscal Intermediary?
The Fiscal Intermediary or FI is an agency that provides administrative and billing support to a person who chooses self-direction. Fiscal Intermediary (FI) is an HCBS Waiver service that funds the financial management of an individual’s Self-Directed Services budget. A Fiscal Intermediary works with the person to implement the person’s desired activities and to complete the billing and payment of the services identified in the budget template as well as proving fiscal accounting and reporting, Medicaid & Corporate Compliance, and general administrative support. The selection of an FI is required when the person has one or more of the following services included in his/her budget: • Individual Directed Goods and Services (IDGS) • Support Brokerage • Community Transition Services (CTS) • Other Than Personal Services (OTPS)- 100% State funded services, or • Self-Hired Staffing for Community Habilitation, Supported Employment (SEMP) or Respite.
In 2015, Citizens was approved to provide Self-Direction Services, including Fiscal Intermediary (FI) and Broker Services.