Consumer-Directed Services: Are You Ready to Hire Your Own Caregivers?

Disclaimer: The following is based on consumer-directed-services rules for the State of Texas and is not intended to: (1) provide specifics on rules elsewhere; (2) guarantee up-to-date information on every law/regulation anywhere; (3) provide instructions on qualifying for Medicaid or any other financial aid; or (4) offer legal advice. If you need help in any of those areas, please consult a professional directly. 

Qualifying for a Medicaid waiver guarantees financial aid for certain disability expenses, including hired caregivers. Unfortunately, it doesn’t guarantee that you’ll get the ideal caregiver. Do any of the following sound familiar?

  • “My child doesn’t like the caregiver the agency sent.”
  • “The caregiver doesn’t understand what we really need.”
  • “Just when things were finally going smoothly, they changed caregivers on us.”
  • “The caregiver is lazy/disrespectful/chronically tardy. When I complained, they said I wasn’t their boss: they work for the agency. And the agency just said they’d ‘look into it’; that was weeks ago, and nothing’s been done.”

The Basics of CDS

Good news: You can choose your own caregivers (and decide their duties and schedules) without losing Medicaid funding. Just tell your case manager that, instead of depending on an agency, you want to go the consumer-directed services (CDS) route.

It’s not quite that simple, of course. Opting for CDS makes you, legally, an employer. And that means getting certain training, following certain rules, and doing extra work. You’re responsible for:

  • Creating and posting job descriptions/job ads (unless you already know whom you plan to hire)
  • Interviewing potential caregivers
  • Initiating background checks
  • Creating a budget that fits your authorized service plan
  • Submitting an official “employment packet” for each new hire
  • Keeping employee timesheets and other records
  • Making sure everyone knows and performs their duties
  • Correcting any misunderstandings or problems involving caregivers
  • Finding a financial management services agency (FMSA) to handle more complicated duties, such as processing payroll and filing employer-related taxes
  • Perhaps designating a representative (or agency) to handle other tasks you’d rather not do yourself

The Employer Mindset

It may look like an impossible workload; and like any learning experience, it can be overwhelming at first. Once you master the basics, however, you’ll likely find yourself with more free time than before. If you doubt it, consider the work (and extra stress) involved in dealing with the agency-related issues described at the beginning of this article.   

Still, there are a few more things to consider before becoming an employer:

  • Have you reviewed all laws (national, state, and local) that cover hiring requirements and employee rights?
  • Can you provide any reasonable accommodations caregivers may need?
  • What personal experience have you had: (1) looking for work; (2) interviewing for jobs; (3) dealing with supervisors; (4) supervising others? What did you learn from these experiences?
  • Are you able and willing to provide feedback on a caregiver’s work: (1) promptly; (2) clearly; and (3) firmly but kindly? Are you prepared to listen to and consider their responses, even when you’re annoyed? (P.S. Don’t forget the positive feedback when they do a great job!)
  • Can you be flexible? For example, if a caregiver calls to tell you they were rear-ended by a truck and can’t make it to your house because their car is now undrivable, can you be empathetic and calm? And do you have a “Plan B” ready, such as a backup caregiver?

If you’ve considered all the above and feel ready for CDS, congratulations! You’ll be joining a growing group of consumers who know the benefits of choosing their own caregivers, and wouldn’t have it any other way.

This article was adapted from BridgingApps’ Consumer Directed Services Help Guide. For a copy of the full Guide, and in-depth details on all things CDS, see our Consumer Directed Services Resource page.

Helpful information: With a CDS arrangement, you’re free to hire people you know personally, including best friends and close relatives. This does, however, mean some extra concerns (and sometimes excess baggage). See companion post, “Consumer-Directed Services: Friends and Family as Paid Caregivers.”

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