Understanding Medicaid Home and Community Services: A Primer, 2010 Edition. Introduction


Participant direction, referred to alternatively as consumer direction, self-direction, and participant-driven supports, is a service model that offers individuals and their families the opportunity, support, and authority to choose the services they need and direct the individuals who provide them.2 Participant direction principles have broad applicability for individuals of all ages who need long-term care services and supports (hereafter called services and supports) due to physical or cognitive impairments, including those caused by serious mental illness, a developmental condition, or dementia.

Participant direction has been demonstrated to promote positive outcomes for individuals and their families, improve participant satisfaction, and increase access to needed services.3 Participant direction service models can be a means to involve individuals and families in quality assurance and improvement efforts, promote effective service delivery, and improve participant satisfaction with services.4

For individuals with intellectual disabilities and other developmental disabilities (hereafter referred to as developmental disabilities), participant-directed services are considered an essential element of self-determination, the philosophy that continues to reshape the provision of services and supports for this population. A key principle of self-determination is that individuals should have the authority to direct and manage their own lives, including their services. Individuals may invite and enlist friends and family members to assist them in directing and managing services.5 An individual’s legal representative or surrogate decision maker may also provide assistance and advice and perform some service management tasks (as they can for all individuals who need assistance to direct their services).

Participant direction models can operate side by side with traditional service delivery models, so individuals and families can choose the extent to which they wish to manage their services. Those who want to exercise a high level of control can select participant direction options, while others can have services and supports managed by a provider agency.

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