Self-Directed Services
A self-directed program, empowers individuals with disabilities to take control over their support services, choosing who provides care, how it's delivered, when, and managing a personal budget, offering more choice than traditional agency models. It's a model focused on person-centered planning, giving participants decision-making power over staff hiring, training, scheduling, and resource allocation to meet their unique goals for independence and quality of life.
Who Benefits
Individuals with Intellectual and Developmental Disabilities (IDD): People who want control over their daily lives, including who helps them, how they get support, and what they do.
Families: Parents and guardians seeking tailored support for children or loved ones with disabilities, managing services effectively.
Those seeking Independence: Individuals looking to build skills for independent living, explore jobs, and participate more fully in their communities.
Community: Local businesses, Direct Support Professionals (DSPs), and community vendors all benefit from the flexibility and employment opportunities generated by Self-Direction.
Currently, more than 3,600 Marylanders self-direct their services. And 20,500 individuals and families rely on IDD services, many of whom would be forced into institutional settings without Self-Direction.
Cost Effectiveness and New Challenges in Self-Directed Services
Data presented to state lawmakers highlights that self-directed services are more cost-effective than traditional models. In fiscal year 2024, the Self-Directed Advocacy Network of Maryland reported that average self-directed budgets were funded $10,737 less and had expenditures $23,859 lower than those associated with traditional services. Despite these cost savings, the self-directed program is now disproportionately targeted by proposed budget cuts and faces increasingly restrictive requirements.
Impact of Enhanced Documentation Standards
To address the ongoing crisis, the state has introduced what officials refer to as "enhanced documentation standards." In reality, these changes have created a complex bureaucratic process and red tape that is difficult for families, many of whom chose self-direction for its flexibility and responsiveness. The new requirements are detailed in a manual that has undergone multiple revisions in 2025, signaling a significant departure from the person-centered philosophy that has defined and contributed to the success of self-direction.
Legal Protections for Self-Direction
Federal regulation 42 CFR Part 441: outlines the protections and responsibilities within self-directed programs.
Self-Direction Act of 2022: Legally established and expanded training and support for self-directed services.
Olmstead Decision (1999): This Supreme Court ruling affirms that individuals with disabilities must receive services in the most integrated setting possible. Self-Direction fulfills this promise by helping individuals stay in their homes and communities.
Medicaid HCBS Waiver Programs: The Community Pathways Waiver supports individuals in avoiding institutionalization, yet funding cuts are making self-directed services harder to access.
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