If you or a loved one qualifies for services through Maryland’s DDA (Developmental Disabilities Administration), one of the big decisions you face is how these services are managed.
You can choose between two models:
- Self-directed services — you’re in charge of managing support services.
- Provider-managed services — an organization handles most of it for you.
This choice affects how you work with supports providers, influences daily life, and shapes the overall journey of the person receiving the supports.
Each model offers different levels of control, flexibility, and responsibility. While both help individuals with autism or I/DD live more independently, they work in very different ways — especially in how decisions are made, how the budget is allocated, and how much you can customize your supports plan.
Let’s walk through what each model looks like in practice — and how they compare.
The traditional approach: Provider-managed services
In a provider-managed model, DDA-approved funding goes straight to a provider organization. The organization uses those funds to deliver services through its existing programs and procedures. That means the organization becomes responsible for delivering your services and managing everything behind the scenes.
They decide:
- How your budget is used
- Which staff members support you
- How your schedule works
- How services are delivered
These decisions are guided by your Person-Centered Plan (PCP), but day-to-day choices are made by the provider, using their systems and staff.
Self-directed services: More control, more responsibility
Self-direction flips the traditional model. Instead of Medicaid funds going directly to a provider, they go through a Financial Management and Counseling Services provider (FMCS). This acts as an escrow service, handling most of the paperwork and payments, while you make the decisions.
You decide:
- How the budget is allocated
- Who you want to work with: individuals, vendors, organizations, or even family members
- When and how services are delivered so they fit your timeline
You can hire staff directly, contract with provider agencies, or combine both.
Comparing both models
Both approaches have distinct pros and cons. Let’s compare them across five key areas of disability supports.
#1: Decision-making and flexibility
The biggest difference between the two models is who makes the decisions.
With self-directed disability services, you’re in charge. You choose staff and vendors, decide when and how services happen, and adjust the plan as needs change. For example, you might spend more on job coaching during some months and more on social skills development during others, depending on your goals and circumstances.
In provider-managed services, the organization makes those decisions. They decide which support staff to hire, set schedules and timelines, and use the budget across their programs and operations. Your preferences are taken into account, but most day-to-day decisions are guided by the provider’s systems and operations.
This works well for those who prefer a structured approach or don’t want to be too deeply involved in all the logistics themselves.
#2: Budget control
With self-direction, you know exactly how your DDA funds are used. You see what each service costs, compare vendors, and decide how much of the budget to spend where. If priorities change or you find a more cost-effective option, you can reallocate funds accordingly. This takes time and effort, but often leads to smarter, more efficient use of resources.
In provider-managed services, the organization manages the budget internally. They receive all the funding and distribute it across services, staff, and other operational costs. You benefit from the services, but don’t see or control the financial breakdown.
#3: Administrative responsibilities
Self-directed services come with a significant administrative load. If you hire staff directly, you’re responsible for recruiting, interviewing, onboarding, supervising, and scheduling. If you’re unsure how to juggle all of it, you can work with a support broker or hire a day-to-day manager to help with this.
In a provider-managed setup, all that is taken care of. The provider handles everything from staffing to payroll to reporting. For many, this simplicity is worth the trade-off in control and flexibility.
#4: Service delivery
Self-direction allows for highly personalized support. You can hire someone who shares your values, understands your communication preferences, or specializes in a particular skill. You can also combine services in ways that aren’t possible with standard provider programs.
In provider-managed models, services are delivered through pre-existing programs. These are typically designed to meet the needs of a wide range of participants, and the staff are often highly trained. But the programs may not offer a high level of customization or adaptability.
#5: Billing and financial relationships
Billing and payments work differently in each model.
If you’re using self-directed services, you have direct relationships with staff and vendors. You receive invoices, approve bills, and your FMCS handles the payments. This gives you a clear picture of where the money goes and more control over how it’s used.
With provider-managed services, all billing is handled between the provider and Medicaid. You receive services without dealing with invoices or payments. It’s more convenient, but it also means you won’t see exactly how the budget is spent.
Why choose one approach over the other
Those who choose self-direction tend to value control, customization, and cost efficiency.
They often have clear ideas about what works best and want the freedom to hire someone they trust. Many prefer working with smaller vendors — either because they’ve had negative experiences with large organizations or because they want to support smaller, or more specialized ones.
Flexibility is another draw. Self-direction lets you make changes quickly when something isn’t working, and combine services to deliver better value. For family members who provide informal support, self-direction also offers a way to get paid for the work they’re already doing.
On the other hand, individuals or families who choose provider-managed services usually prefer having an organization handle all the details.
They may feel more comfortable with a set schedule and structured program and prefer having one organization manage everything — from staffing and payroll to compliance and logistics. Knowing that backup staff are always available can also bring peace of mind.
For those who don’t have the time or energy to manage services themselves, this can be a more practical option.
Switching between approaches
One important thing to keep in mind: your choice isn’t final. As your needs, circumstances, or comfort level with managing services change, you can revisit your decision. Maryland’s system allows participants to switch between self-directed and provider-managed services at any time.
However, the move between models needs to be planned carefully to avoid service gaps. You’ll need to work with your Coordinator of Community Services (CCS) and any current providers to make sure supports aren’t interrupted during the transition.
If you’re moving toward self-direction, your CCS will help you update your Person-Centered Plan and get set up with an FMCS provider. You may also need to complete training on managing services and becoming an employer of record.
If you’re shifting to provider-managed services, your CCS can help you select a provider organization and guide you through the transition.
Making the choice that’s right for you
Here are some questions to help you decide which services model is right for you:
Control and customization:
- Do you have strong preferences about which supports are available to you?
- Are you looking for combinations that don’t fit standard program models?
- Do you want to decide who to hire and how to allocate your budget?
Administrative capacity:
- Do you have the time and energy to manage staff and service providers?
- Are you comfortable hiring and managing staff directly?
- Do you want to be responsible for allocating budget, approving invoices, and reviewing how services are working?
Flexibility and change:
- Do you want or need to adjust services regularly?
- Are you looking for staff and providers who work with you and adapt their approach when needed?
Values and priorities:
- Do you prefer working with smaller or more specialized providers, rather than large organizations?
- Is it important to you to see exactly how your Medicaid funds are used?
- Do you want the option to hire family members as paid staff?
If you answered “yes” to most of these questions, then self-direction may be an option for you.
Both self-directed and provider-managed services can lead to great outcomes. The right choice isn’t about which approach is objectively better; it’s about what works for you. Your choice should reflect your priorities, available time and energy, and goals.
Whether you choose self-direction or provider-managed services, the key is working with organizations that understand what matters to you and respect your preferences.
At Elevate Spectrum, we support both self-directed and provider-managed participants, adapting our approach to fit your chosen service model and help you reach your goals.
Get in touch today to find out more about how we can support you.
