What if you could have more say in who provides your care, when you receive it, and how that care fits into your daily life?
For Arkansans over the age of 18 living with a disability, chronic health condition, or long-term care need, those decisions can make a meaningful difference. Having a caregiver you know and trust—or simply having more flexibility around your schedule—can help care feel more personal and better aligned with your needs.
For some Arkansas Medicaid beneficiaries, self-directed care may provide that flexibility.
Self-directed care allows eligible participants to take a more active role in managing certain Medicaid-funded services. It is not the right choice for everyone, but for people who want greater control over their care, it can be an important option to understand.
What Is Self-Directed Care?
Arkansas Medicaid beneficiaries may receive certain services through one of two general care-delivery models: traditional agency-based care or self-directed care.
With traditional agency-based care, a provider agency employs caregivers and assigns staff to deliver authorized services.
Self-directed care works differently. Instead of relying on an agency to select and manage caregivers, the participant takes on many of those responsibilities directly.
On the self-directed program, a participant is able to:
- Recruit and select a caregiver
- Hire someone they know and trust
- Help train the caregiver based on their individual needs
- Supervise the caregiver’s work
- Have greater input into when authorized services are provided
The caregiver may be a qualifying family member, relative, friend, neighbor, or another individual chosen by the participant.
That added choice can make it easier to build a support system around the participant’s daily routine, preferences, and personal needs.
Self-Direction Means More Choice—and More Responsibility
Greater flexibility also comes with additional responsibility.
Participants in self-directed programs take on many of the duties typically handled by a traditional employer, including selecting caregivers, providing direction, reviewing services, and supervising the people who assist them.
For some individuals, that level of involvement feels empowering. Others may prefer having an agency manage caregiver hiring, staffing, and scheduling.
Participants do not have to manage everything themselves. If a participant needs assistance carrying out employer responsibilities, an authorized representative may be able to help manage care on the participant’s behalf, subject to program requirements.
There is no universally “better” care model. The right choice depends on the individual, their support system, and how involved they want to be in managing their services.
What Services Can Be Self-Directed in Arkansas?
Self-direction is available for certain personal care services through Arkansas Medicaid.
Participants in the ARChoices waiver and in the IC Only program have the option to self-direct attendant and personal care services.
Personal care services may include hands-on assistance with everyday activities such as:
- Bathing
- Dressing
- Grooming
- Using the restroom
- Moving safely through daily routines
- Other authorized personal care needs
Eligibility for these services—and the amount of care an individual is authorized to receive—depends on the person’s circumstances and applicable Arkansas Medicaid requirements.
Self-direction does not create additional Medicaid benefits. Rather, it changes how certain authorized services are delivered and managed.
You Don’t Have to Manage Self-Direction Alone
The phrase “self-directed” can sometimes sound as though participants are expected to handle every administrative detail by themselves.
That is not the case.
Public Partnerships, LLC (PPL) serves as the financial management services provider for Arkansas’s self-directed programs. PPL helps participants manage many of the administrative responsibilities associated with employing caregivers.
That support includes:
- Caregiver enrollment and credentialing
- Payroll processing
- Payroll taxes
- Required background checks
- Electronic visit verification
- Time-entry administration
- Other program-related requirements
Participants are also assigned to a support broker who will help them understand program requirements and navigate the self-direction process.
PPL’s role is administrative. PPL does not determine whether someone qualifies for Medicaid, authorize Medicaid services, or create an individual’s care plan. Those decisions remain with the appropriate Medicaid and program authorities. Instead, PPL helps make it possible for participants to manage self-directed services while meeting applicable administrative requirements.
How Does Self-Direction Protect Participants and Medicaid?
Self-direction gives participants greater control, but that flexibility exists within a system of safeguards.
Caregivers must complete applicable screening and credentialing requirements before providing services.
Electronic Visit Verification (EVV) is used to document information about service visits, helping confirm that authorized services were delivered as reported.
In addition, time entries may be reviewed against:
- Approved service authorizations
- Applicable budgets
- Program requirements
- Other Medicaid rules
Potential problems or inconsistencies may also be monitored and reviewed.
These safeguards are designed to balance two important goals: giving participants meaningful choice while ensuring Medicaid-funded services are properly authorized, documented, and delivered.
Will Self-Direction Affect Your Medicaid Coverage?
Choosing self-directed care does not change a person’s underlying Medicaid coverage.
Self-direction is simply one method of receiving and managing certain Medicaid services.
Likewise, if a participant decides that self-direction is no longer the right fit, leaving the self-directed program does not automatically mean losing Medicaid coverage.
As long as the person continues to meet applicable eligibility and service requirements, they may be able to receive eligible services through another care-delivery model, such as an agency.
This distinction is important: Medicaid eligibility and self-direction are not the same thing.
Is Self-Directed Care Right for You?
Self-direction can be appealing to people who want greater involvement in their care.
It may be worth considering if you value:
- Choosing your own caregiver
- Working with someone you already know and trust
- Having more control over your care schedule
- Taking an active role in supervising your services
- Building care around your individual routine and preferences
On the other hand, agency-based care may be a better fit if you prefer having someone else manage caregiver recruitment, employment, staffing, and scheduling.
Neither choice is inherently better. What matters is finding the care model that works best for you.
Know Your Options
One of the most important things Arkansas Medicaid beneficiaries can do is understand the choices available to them.
If you currently receive Medicaid-funded personal care or waiver services, ask whether self-direction is available for the services you receive and whether you meet the applicable program requirements.
If you do not currently receive Medicaid but believe you may qualify, you can apply for coverage through the Arkansas Department of Human Services, including through Access Arkansas.
Healthcare decisions can feel complicated, particularly when long-term care and daily support are involved. Understanding self-directed care gives beneficiaries and families another option to consider—and potentially a greater voice in how care is provided.
