Understanding Consumer Direction in Long Term Care

Page Reviewed / Updated - Jan. 2014

 Consumer directed care means the consumer chooses their own care providers instead of a state agency dictating what care is required, by whom and when that care is delivered.

Definition: Consumer Directed Care

In the context of long term care, consumer directed care refers to a system in which the individual in need of care or their family and legal guardians determine what care services and supplies are necessary. The individual or their family select, retain and manage their care providers and to an extent they manage payment to their providers usually within an agreed upon, pre-determined budget.

Consumer directed care means the consumer chooses their own care providers instead of a state agency dictating what care is required, by whom and when that care is delivered. Generally speaking, by putting the consumer in charge of their own care, the consumer receives higher quality care, customized for their needs, enjoys greater flexibility, control and satisfaction from the care they receive. Theoretically, consumer directed care also generates cost savings for the states as they are relieved of providing some care management services.

One of the most popular aspects of consumer direction and the reason for which many families seek out these programs is because family members can be paid for the care they provide.  Learn more.

 Did You Know?
Consumer directed care is a relatively new concept having started in the 1990s as a backlash to the limited control consumers had under the emerging HMOs. 


Other Names for Consumer Direction

There is no single, national consumer directed care program; instead this is a concept which is played out in many different programs referred to by different names and acronyms. Consequently there is often confusion around consumer directed care. One may also hear it referred to as:

  • CDC
  • Consumer Directed Services
  • Participant Directed Care
  • Participant Direction
  • Self-Directed Care
  • Consumer Directed Medicaid Waivers

Adding further confusion is the fact that many states have their own names for their specific programs. For example, in Florida it is called the Care Plus Program, in Texas CDS or DADS, in New York, CDPAS and in New Mexico, Mi Via.


Types of Consumer Directed Care

 Consumer directed care programs are now available in nearly every state.

Medicaid’s Cash and Counseling program is one popular program rolling out across the states in which the family caregiver can be paid for the personal care they provide to their loved ones.

Veterans Directed-HCBS Program, as the name implies, is a program that allows veterans to direct their own care services. While it does not provide them with cash directly, it does put them in charge of a care budget and allows them to authorize payments to care providers.

State Medicaid HCBS Waivers are the most common programs with consumer direction.  Under some waivers, consumer direction is automatic and in others, it is considered an add-on and enrollment may be limited.  The amount of participant control varies from waiver to waiver and state to state.  On this website, we maintain a complete list of Medicaid waivers that one can review to find programs for which they are eligible and a list of Medicaid waivers with consumer direction.

So popular is this concept that some states have even begun to allow for self-direction of care services in their non-Medicaid elder care assistance programs.  A list is here.