Self-Directed Home Care in PA: Taking Control of Your Care Plan

Self-directed care means exactly what it sounds like: the person receiving care gets to decide who provides it, when it happens, and how it’s delivered. In Pennsylvania’s Medicaid system, this isn’t just a philosophy — it’s a specific program option called Participant-Directed Services, and it’s the mechanism that gives families control over their home care.

If you or your loved one wants to choose a trusted family member as the caregiver instead of accepting whoever an agency sends, self-directed care through PDS is how you make that happen.

What Self-Directed Care Means in Pennsylvania

Under Community HealthChoices and other PA Medicaid waiver programs, participants who qualify for home and community-based services have a choice in how those services are delivered. The default is the traditional agency model: an agency assigns a caregiver, sets the schedule, and manages the care. The participant has limited control over who shows up.

The alternative is Participant-Directed Services (PDS). Under PDS, the participant becomes the decision-maker. They select their own caregiver — which can be a qualifying family member. They direct what tasks are performed and when. They determine the schedule that works for their life. And the caregiver they choose is hired through the Agency with Choice model, which handles payroll, taxes, and employment compliance.

Self-directed care doesn’t mean the participant is alone. A service coordinator remains involved, the care plan still guides what services are authorized, and the AWC organization handles all administrative responsibilities. The participant isn’t taking on the burden of running a business — they’re simply exercising the right to choose who cares for them.

Why Self-Direction Matters

The practical benefits of self-directed care are significant. The caregiver already knows the participant — their preferences, their routines, their dietary needs, their communication style, their cultural practices, their sense of humor, their fears. There’s no adjustment period, no awkward introductions, no stranger learning the basics of who this person is.

The schedule is flexible. Unlike agency-based care, where shifts are set by the agency and may not match the participant’s actual needs, self-directed care lets the family arrange hours around real life — morning routines, medical appointments, family events, the caregiver’s other commitments.

Continuity is built in. One of the biggest complaints about agency-based care is the revolving door of caregivers — different people showing up on different days, each one needing to relearn the participant’s needs. With a family caregiver through PDS, the same person provides the care consistently.

And trust is inherent. For many participants, especially those from communities where family care is the cultural norm, having a stranger provide intimate personal care — bathing, dressing, toileting — is deeply uncomfortable. Self-directed care solves this at the root.

Who Can Self-Direct

Any participant in Community HealthChoices or an applicable waiver program who qualifies for home and community-based services can request Participant-Directed Services. The participant (or their authorized representative) must be willing and able to manage the employment relationship — which primarily means directing the caregiver’s work and approving timesheets.

If the participant has cognitive limitations that prevent them from managing these responsibilities, a representative (such as a family member who is not the caregiver) can serve in this role on their behalf.

How to Request PDS

If your loved one is already enrolled in CHC and receiving services through a traditional agency, they can request a switch to Participant-Directed Services at any time. Contact the MCO’s service coordinator and indicate that the participant wants to self-direct their care and name a family member as their caregiver.

If your loved one is newly enrolling in CHC, request PDS during the initial care planning process. Don’t wait to be offered it — the default in many cases is the agency model, and PDS may not be mentioned unless you ask.

Once PDS is activated, the chosen family caregiver completes the Agency with Choice onboarding (background checks, employment paperwork, direct deposit setup), and services begin under the participant’s direction.

CareChoice and Self-Directed Care

CareChoice operates within the self-directed care model. We serve as the infrastructure that makes PDS work for families — handling the AWC enrollment, payroll processing, compliance requirements, and ongoing support so that the participant can focus on directing their care and the family caregiver can focus on providing it.

If self-directed care sounds like what your family needs, we can help you navigate the request and get everything in place.

Get started → Contact CareChoice

Related: Get Paid to Care for Family in PA → | Agency with Choice in PA → | CHC in Philadelphia →