Self-Direction/IndependentChoices

What is IndependentChoices (Self-Direction in Arkansas)?

Self-directed Medicaid services means that participants, or their representatives (if applicable), have decision-making authority over certain services and take direct responsibility to manage their services with the assistance of a system of available supports. The self-directed service delivery model is an alternative to traditionally delivered and managed services, such as an agency delivery model. Self-direction of services allows participants to have the responsibility for managing all aspects of service delivery in a person-centered planning process.

Self-direction promotes personal choice and control over the delivery of waiver and state plan services, including the choice of who provides the services and how services are provided. In the state of Arkansas, there are currently two (2) programs offering the self-direction model:

IndependentChoices (1915j State Plan Services)

ARChoices (1915c HCBS Waiver Services)

Participants on either of these programs choosing the self-direction model are afforded the responsibility to recruit, hire, train and supervise the individuals who furnish their services. The Centers for Medicare & Medicaid Services (CMS) calls this “employer authority.” Participants may also have decision-making authority over how the Medicaid funds in a budget are spent. CMS refers to this as “budget authority.”

Self-direction services give Medicaid recipients another choice of how to receive personal assistance services in their home. Participants and/or representatives have more control of how their personal assistance needs are met. They receive a cash allowance for their personal care assistance services and can decide how it will be spent. They may choose to use their entire allowance to pay their personal assistant or choose to use part of their allowance to purchase other items that support their care and independence.

With self-direction, the participant/representative decides:

Who provides their care

When their personal assistant works

What their personal assistant does for them

How their personal assistant takes care of them

What other items they need to enhance their quality of care and independence

There is also more responsibility when participating in a self-direction program. These responsibilities include:

Hiring or firing their personal assistant

Directing their personal assistant on how they would like things done

Scheduling when the personal assistant comes to their home

Keeping up with when the personal assistant works and approving their time

Possibly keeping up with receipts if they choose to use part of their cash allowance to purchase items

Participants using the self-direction model will work with a Financial Management Service (FMS) vendor who has contracted with DHS. The FMS vendor is not a provider and does not have Employer Authority. This FMS vendor assists individuals in exercising their budget authority, such as:

Understanding billing and documentation responsibilities

Performing payroll and employer-related duties such as withholding and filing federal, state, local and unemployment taxes

Purchasing workers’ compensation or other forms of insurance

Collecting and processing worker timesheets

Calculating and processing employee benefits

Issuing payroll on behalf of the employer/participant

Purchasing approved goods and services

Tracking and monitoring individual budget expenditures

Identifying expenditures that are over or under the budget

DHS is currently contracted with Public Partnerships, LLC. as the FMS vendor for the state of Arkansas as of October 1, 2023. See our Financial Management Services page for more detail about our vendor, Public Partnerships (PPL).

ELECTRONIC VISIT VERIFICATION (EVV)
See our self-direction EVV page for more detail.

For questions, please contact PPL’s Customer Service at 1 (800) 256-2913.

Who should I talk to with questions?
• Your Public Partnerships Account Manager is happy to help you with any general questions or information. They will also update you, including any impact to your program during the down time, during any regularly scheduled meetings.