Medicaid Waiver (3) MCOs Consumer Directed

**Agency-Directed** services  are an alternative to consumer-directed services for individuals who qualify for Medicaid home- and community-based services (such as the Waiver or Developmental Disabilities Waivers).

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## **What Are Agency-Directed Services?**

**Agency-directed** means that a **Medicaid-enrolled home care agency** is responsible for hiring, training, supervising, and paying the caregivers who provide personal care, respite, or companion services to the individual.

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### **How Agency-Directed Services Work**

1. **Assessment & Authorization**
- The individual is assessed by a case manager or service facilitator to determine eligibility and the number of hours/services needed.
- The individual (or their representative) selects an approved home care agency from a list provided by Medicaid or their managed care plan.

2. **Caregiver Assignment**
- The agency assigns a qualified caregiver (Personal Care Aide or Direct Support Professional) to provide the approved services.
- The agency is responsible for background checks, training, and ongoing supervision of the caregiver.

3. **Supervision & Support**
- The agency supervises the caregiver, handles scheduling, and ensures that care plans are followed.
- If the assigned caregiver is unavailable, the agency is responsible for providing a substitute.

4. **Payroll & Administration**
- The agency handles all payroll, taxes, insurance, and employment paperwork.
- The individual receiving care does not have employer responsibilities.

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## **Benefits of Agency-Directed Services**

- **Less Responsibility for the Individual:** The agency manages all aspects of employment, so the individual or their family does not need to recruit, hire, train, or supervise caregivers.
- **Professional Supervision:** Caregivers are trained and supervised by the agency, which may provide higher consistency and oversight.
- **Backup Care:** If a caregiver is unavailable, the agency can send a replacement.
- **No Employer Paperwork:** The agency handles payroll, taxes, and insurance.

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## **Limitations**

- **Less Choice:** The individual cannot select their own caregiver (though they can request a change if dissatisfied).
- **Less Flexibility:** Scheduling may be less flexible than the consumer-directed model.
- **Family Members:** Most family members **cannot** be paid caregivers through the agency-directed model (with some exceptions for certain waivers and relationships).

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## **Who Should Consider Agency-Directed?**

- Individuals who do **not** want the responsibility of managing their own care or hiring/firing caregivers.
- Individuals who prefer a more structured, agency-managed approach.
- Individuals who do not have a family member or friend available to serve as a caregiver.

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## **How to Access Agency-Directed Services**

1. **Contact your Medicaid Managed Care Plan, local Department of Social Services, or Service Facilitator.**
2. **Request agency-directed services.**
3. **Select an agency from the approved list and begin services after assessment and authorization.**

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**In summary:**
Agency-directed services put the responsibility for hiring, training, and supervising caregivers in the hands of a professional agency, offering convenience and support for those who do not want to self-manage their care.