3 Myths, and 3 Facts, About Self-Directed Care 

When Florida-based Independent Living Systems made its move into becoming a health plan in 2018, they needed a partner that could support self-directed care. That’s no small task.

​​​“We needed a partner that was experienced in that space that could help us administer that part of the Medicaid long-term care program in Florida,” says David Rogers, president of Independent Living Systems (ILS). “We selected PPL to do that work. And they’ve been with us ever since as our fiscal intermediary — our self-direction vendor since we launched our health plan.”

Public Partnerships LLC., or PPL, delivers critical support in self-directed care. The myths around the model threaten to overtake it. The reality is different: self-directed care is a critical Medicaid support that helps older adults and people with disabilities live independently at home.

As states continue investing in home- and community-based services, self-directed care has become the subject of misconceptions around how these programs operate, who they serve​,​ and what oversight systems are in place to ensure accountability, transparency and responsible stewardship of taxpayer dollars.

Three major myths are driving conversation about self-directed care. The facts set the record straight.

Myth #1: Self-directed care programs are fraught with fraud and lack oversight.

Fact: Strong fiscal intermediaries create the oversight and accountability that protect self-directed care programs.

These organizations build oversight into every step of self-directed care programs. Fiscal intermediaries (FI) help states verify eligibility and authorizations, monitor timekeeping and payments, and flag irregular billing patterns.

By creating standardized processes and centralized visibility across the program, strong FIs help detect and prevent improper activity early while protecting both participants and taxpayer dollars.

“Think about what employers generally do: they manage workers, which raises questions around choice and control,” Rogers says. “But a big task for employers is making sure those workers will get paid. So PPL does all of the payroll functions for our members who are participating in that self-directed model.”

Myth #2: Self-directed care means people are left to manage care completely on their own.

Fact: Self-directed care combines participant choice with professional support and program guidance.

While managing payroll in home-based care is a challenge, the challenge is nothing like payroll in self-directed care.

“People think, you know, it’s just running payroll,” Rogers says. “But these [workers] aren’t healthcare providers. These are seniors, or a family member.”

Self-directed care allows individuals to make decisions about who provides their care and how services fit into their daily lives, while still operating within a structured support system. FIs, care managers and state partners help participants navigate enrollment, payroll, authorizations, timekeeping and program requirements.

Many programs also provide dedicated support resources, including multilingual call centers, culturally competent staff, in-person assistance and technology tools that help participants and caregivers manage services more easily.

This combination of personal choice and administrative support helps individuals maintain ​their ​independence while ensuring services are coordinated, compliant​,​ and aligned with their care needs.

“Healthcare is a complicated system. Medicaid is more complicated. Now you’re adding another complicated system: the IRS,” Rogers says. “That’s the kind of support that PPL can provide our members.”

Myth #3: Self-directed care contributes to the caregiver shortage.

Fact: Self-directed care is stabilizing the caregiving workforce.

The United States is facing a shortage of caregivers across the healthcare system. Self-directed care is helping to address that challenge by allowing individuals to hire people close to them who they trust. By professionalizing the caregiver role, self-directed care helps to broaden support networks while improving continuity of care for participants.

Strong FIs help stabilize the caregiving workforce through accurate and reliable payroll processing, training and administrative support, making it easier for more people to step into the caregiver role and stay in it.

“We really believe in partnerships — and having spent a lot of our 25-year history as a vendor to health plans, we’re not interested in having contractors or vendors,” Rogers says. “We want partners. And I think one of the things that I’ve appreciated with PPL is that they view the relationship the same way. Not every vendor is like that. Not every fiscal intermediary has that mindset. PPL does. It’s a true partnership.”

This Views article is sponsored by PPL, and is adapted from PPL’s “Myths vs. Facts: Understanding Self-Directed Care.” To learn more about self-directed care, visit PPL at pplfirst.com.

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