For many adults with autism and I/DD, getting supports means working with a provider who makes the decisions about how service budgets are spent. But more and more people are choosing a different path: self-direction, where you have more control over your budget and can choose your own service providers.
What started as a small movement has become the go-to option for many. It’s not just a passing trend; it’s a sign that individuals and their families want more say, more flexibility, and a better fit for their unique needs.
How self-direction works in Maryland
Self-direction doesn’t mean you get a chunk of money to spend however you like. In Maryland’s DDA system, self-directed funds are held by a Financial Management and Counseling Service (FMCS), which acts as the go-between. They handle the payments, but you decide how the money is used.
You create a detailed budget that spells out how the funds will be used: which services you want, which staff or vendors you’ll work with, and how much each will be paid.
Instead of the provider organization billing Medicaid directly for services, here’s what happens:Â
- You approve the bills and payments for services and goods delivered to you, and send these to the FMCS for processing
- The FMCS pays your staff or vendor
- Then, the FMCS bills Medicaid
The biggest difference is control. With traditional provider-managed services, the organization decides how the funds are used across its programs. With self-direction, you decide. You might work with one vendor for job training, another for housing support, and a third for daily living skills, depending on what works best for your situation.
When you hire a vendor or staff for self-directed services, you work directly with them. They send invoices to your FMCS account instead of billing Medicaid directly. That gives you a closer working relationship — and usually, more say in how things are done.
Why choose self-direction?
Complete decision-making power: You choose which services to prioritize, who to work with, and how to combine different types of support. This level of choice is especially helpful for individuals and self-advocates whose needs and preferences don’t fit into standard programs.
Flexibility in who provides support: With self-direction, you’re not limited to working with whoever gets picked for you. You can choose to work with smaller vendors, hire individual staff directly, or even pay a family member, friend, or neighbor to help out. This creates a support structure that’s more tailored and adaptable, rather than one-size-fits-all.
A better fit for your goals: Self-direction lets you focus your budget on what matters most to you — whether that’s employment, living more independently, or building social skills. You’re not forced to fit your needs into a provider’s pre-designed program.
Direct relationships with staff and vendors: You hire the people you want to work with and develop a relationship with them. If someone works with you directly instead of through a large organization, it often means more personalized attention and responsive service.
Easier to make changes: Your budget isn’t set in stone. If a vendor isn’t a good fit or your goals change, you can adjust the services you need. You’re not tied into long contracts or stuck on an organization’s waitlist.
More cost-efficient use of your budget: With self-direction, your Medicaid funds go directly toward the services you actually need, instead of being spread across programs where only parts of them apply to your situation. That means less waste and more impact.
Potential challenges to consider
Planning and monitoring the budget: Creating a budget means thinking ahead about what support you need now and what might change in the future. You’ll need to plan for seasonal variations, anticipate service transitions, and balance different types of support within your total budget.
Finding and managing staff and vendors: It takes time to find good people. You’ll need to research, check references, and maintain relationships with the people and organizations you’re working with.
Quality oversight: Since you’re in charge, you’ll need to stay involved and monitor the quality and outcomes of each service. If a service isn’t working well, it’s up to you to make changes.
Is self-direction right for you?
Self-direction works best when you want full control over your budget and how it’s spent. If you’re not naturally organized or you’re unsure how to manage budgets or projects, there are support brokers and day-to-day managers who can help with organization and staying on top of things.
Provider-managed services might be a better fit if you’d rather have one organization handle most of the coordination, if managing multiple vendors and staff feels overwhelming, or if you’re satisfied with the service packages you’re currently receiving.
Here are a few questions to think about:
- Do you want direct control over how your budget is spent?
- Are your needs different from what most programs offer?
- Do you have strong opinions about how services are delivered or combined?
- Are you comfortable researching and hiring potential service providers?
- Do you have time to manage relationships with staff and vendors, and track spending?
- Are you willing to track outcomes and make changes when needed?
If you answered yes to most of these, self-direction might be a good match.
Still not sure which model is right for you? Compare self-direction with provider-managed services.
How we work with self-directing individuals
Unfortunately, not all vendors understand self-direction or even offer services to those who self-direct. At Elevate Spectrum, we’ve been working with self-directing individuals and families for many years. Recently, we’ve seen a significant rise in the number of self-directing participants (as opposed to those who join our programs or receive our services through larger provider agencies).
We strongly believe that every individual has unique needs, especially those with autism or I/DD. That’s why larger providers or standard programs might not be able to offer the right mix of support for each person. And that’s what makes us different: programs like FastTrack to Work (a paid internship with individualized support) and Smart Living (a blend of innovative tech and remote support, built into regular homes) are personalized to each participant. That way, we can offer the exact type and amount of supports an individual needs to reach their goals and increase their autonomy.Â
Getting started with self-direction in Maryland
The steps to begin self-directing services in Maryland depend on your current situation.
If you’re already using provider-managed services, you can usually request to switch to self-direction during your annual planning meeting or when your current services come up for renewal.
If you’re new to the DDA system, you can choose self-direction during your initial service planning process.
You’ll start by working with a Coordinator of Community Services to outline your needs and goals, and build your Person-Centered Plan (PCP). That plan becomes the basis for your budget. Then you’ll choose a Financial Management and Counseling Services provider (FMCS) to set up your account and create your initial budget.
Your support coordinator can walk you through the details and connect you with helpful resources for self-direction.
Choosing between self-direction and provider-managed services isn’t about which approach is better overall. It’s about which approach aligns with your preferences, capacity, and goals. Both can work well when they match your situation and priorities.
If you’re considering self-direction, a good first step is talking with a professional who knows the system and can help you weigh your options based on your specific circumstances.
Want to see how self-direction could work for you? Book a call with one of our team members to talk it through.
