U.S. flag

An official website of the United States government

Self-Directed Personal Assistant Services 1915 (j)

Self-directed personal assistance services (PAS) are personal care and related services provided under the Medicaid State plan and/or section 1915(c) waivers the State already has in place.

  • Participation in self-directed PAS is voluntary
  • Participants set their own provider qualifications and train their PAS providers Participants determine how much they pay for a service, support or item

1915(j) State Options

States can:

  • Target people already getting section 1915(c) waiver services
  • Limit the number of people who will self-direct their PAS
  • Limit the self-direction option to certain areas of the State, or offer it Statewide

At the States option, people enrolled in 1915(j) can:

  • Hire legally liable relatives (such as parents or spouses)
  • Manage a cash disbursement
  • Purchase goods, supports, services, or supplies that increase their independence or substitute for human help (to the extent they'd otherwise have to pay for human help)
  • Use a discretionary amount of their budget to purchase items not otherwise listed in the budget or reserved for permissible purchases

1915(j) Person-Centered and Directed Planning Process

  • Service plan is based on an assessment of need for PAS
  • Service plan and budget plan are developed using a person-centered and directed process
  • Participants can engage in and direct the process
  • Participants can choose family, friends, and professionals to be involved as needed/wanted
  • Participants' preferences, choices, and abilities, as well as strategies to address these preferences must be identified in the service plan

The plan must include an assessment of contingencies that pose a risk of harm to participants and an "individualized backup plan" to address those contingencies, as well as a "risk management plan" that outlines risks participants are willing to assume.

For more information on Supports Brokers & Consultants, Quality Assurance and Improvement Plan, and Financial Management Services (FMS), refer to the Self Directed Services Page.