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Self-determination, also called self-direction, is a service delivery model within HCBS waiver and state plan programs that gives individuals with disabilities (or their families) control over their own services and budgets. Under self-direction, participants receive an individual budget based on their assessed needs and can decide how to spend it — hiring their own workers (including family members in some states), choosing service providers, and deciding when and where services are delivered. There are two main models: employer authority (the participant acts as the employer of their workers) and budget authority (the participant manages an allocated budget for services). A fiscal management service handles payroll, taxes, and billing. Self-determination is rooted in the disability rights principle that people with disabilities should direct their own lives.
Self-direction gives families flexibility that traditional waiver services cannot. You can hire workers you trust, set your own schedule, and tailor services to your family's needs. Ask your waiver case manager if self-direction is available in your state.