A Guide to Self-Directed Care in Maryland

What you’ll learn

Learn how self-directed care supports customized long-term services for people with developmental disabilities, and what to consider if you live in Maryland.

• What is self-directed care?
• Who is self-directed care for?
• How self-directed care works in Maryland
• The benefits of self-directed care
• Self-directed care services from Bello Machre
• FAQs about working with Bello Machre

What is self-directed care?

If you (or a loved one) are receiving long-term care services and are looking for greater autonomy over who provides care and how care-related finances are handled, self-directed care may be worth considering.

Typically available to those who qualify for long-term care under Medicaid, self-directed care gives you (or your representative) greater decision-making authority to directly manage when, where, and how your care is delivered. Also referred to as consumer-directed care or participant-directed care, this care model prioritizes personal choice and independence with person-centered planning at its core.

Who is self-directed care for?

Self-direction can be a great fit for individuals with intellectual and developmental disabilities who are looking for a more personalized long-term care experience. Falling under the umbrella of consumer-directed state assistance programs, Medicaid self-directed services expand the scope of who you can select as a caregiver and how you fund services that support your life goals.

If you have already been approved for the Maryland Community Pathways Waiver you are already part of a Medicaid Home & Community-Based Services (HCBS) Program. This makes you a great candidate for self-directed services. You can start by choosing your preferred self-directed service model, and then making sure you meet its requirements.

How self-directed care works in Maryland

Self-directed care is available in many locations across the U.S. While the basics of the program tend to be the same, there can be nuances by state. 

If you’re considering adopting or switching to a self-directed care model in Maryland, here is what you need to know for participation and enrollment.

KEY ROLES & RESPONSIBILITIES WITHIN A CONSUMER-DIRECTED CARE MODEL

When considering self-directed care for the first time, it’s good to start with an understanding of the people involved with self-directed support guidance. These are the common roles you’ll encounter and what each role entails.

• Participant. This is the individual with disabilities who qualifies for self-directed services and is the primary decision-maker responsible for care management. This can be you (or your loved one). 
• Family. Participants can choose to have family members help with designing budgets, creating care plans, and providing additional support.
• Coordinator of Community Services (CSS). Also referred to as a support broker, this person acts as the participant’s main facilitator within the system, helping them navigate services, develop plans, facilitate meetings, and empower them to make care decisions.
• Fiscal Agent. Also referred to as Fiscal Management Services (FMS) or a Fiscal Intermediary (FI), this third-party organization helps participants understand the financial and administrative aspects of self-directed care, facilitates hiring of vendors and providers and manages disbursement of funds, payroll, and taxes.
• Vendor. This is an independent organization or agency that provides services (e.g., transportation, community services, employment services) to participants, often on a contract basis. 
• Provider. This is a person employed by the participant to provide specific care services (e.g., companionship, daily living tasks, hands-on care) not related to financial matters.

HOW TO ENROLL IN A SELF-DIRECTED CARE PROGRAM

Here is a high-level overview of the steps you’ll want to think about if you decide to enroll in a Medicaid consumer-directed care model. This is by no means an exhaustive list, but rather a starting point highlighting important milestones in your enrollment journey.

1. Confirm Medicaid eligibility. If you’re already receiving long-term care services through Bello Machre or another provider, you’re likely already on Medicaid. But to be sure, or to qualify for the first time, visit Maryland Health Connection.
2. Connect with your CCS. Let them know you’re interested in self-direction so that they can make a referral on your behalf via Maryland’s Long-Term Care Services (LTSS) platform. 
3. Keep working with your CCS. They will help you select a Financial Management Services (FMS) provider, create your self-direction plan, and get the plan approved.

The benefits of self-directed care

Participant-directed care gives those with disabilities greater power to map and control their care journey. If you (or a loved one) are looking for a more tailored, customized approach to long-term care, self-direction offers that. Consider these benefits:

• Hire who you want. Employ and train a team of hand-picked staff and caregivers to provide the exact services you want when you want them. Even work with family and friends if you want!
• Tailor support to your needs. Looking for greater community engagement? Want more targeted career guidance? Need more help with daily living tasks? You decide what care delivery that aligns with your lifestyle looks like.
• Control where funds go. You make the budgets and manage Medicaid funds, for greater say and flexibility in how, when, and where caregiving dollars are spent.
• Gain autonomy in your life. Feel empowered to reach your goals, achieve a greater sense of independence, and gain confidence to live in the world on your terms. 

Bello Machre as a self-directed care services provider

Did you know you can designate Bello Machre as your chosen provider for employment and community services under a self-directed care model? We partner with you to help craft a self-directed care program that fits your needs and your budget.  

With Bello Machre as your provider, you have access to the same dedicated services we offer under non-self-directed models (excluding residential services). Community Services may be provided on a 1:1 or group basis, depending on your preferences, while Employment Services, including job coaching, job development, training, retention, and ongoing support, are delivered on an individualized basis.

We help you take advantage of:

• More individualized services
• Deeper career exploration
• Custom programs that match services to budget

If you’re already receiving services with Bello Machre and looking to switch to self-direction, making the move is easy (follow the same admissions process) and fast (takes about 45 days or fewer). If you’re new to Bello Machre, you can start by reaching out to us. 

In either case, there’s no risk. If at any time you feel that selecting self-directed care with Bello Machre as your provider was not the right decision, you can discontinue your services.

Empowered support with Bello Machre 

Bello Machre is committed to helping you and your family find the right support model. If you’re interested in learning more about self-directed care, or services delivered through a traditional model, please contact us anytime.