Free Resource
What Families Should Know About Self-Direction
Self-direction can offer families more choice over who provides support, what they are paid, and how services are scheduled. It also shifts meaningful responsibilities from a provider agency to the individual or family. This guide is designed to make those trade-offs easier to see.
The big idea
Provider-led services generally cost more per service hour because the agency rate supports more than the DSP’s paycheck: recruitment, supervision, training, compliance, payroll, billing, insurance, administration, and coverage systems are all part of the provider’s operating model.
With self-direction, the family gains more control — but also takes on more of the management work.
Part One — Choosing how supports are managed
Self-direction vs. provider-led services
The core difference is not simply “who pays the worker.” It is who is responsible for building and managing the support system around that worker.
| Responsibility | Self-direction | Provider-led |
|---|---|---|
| Who finds the worker? | The individual or family recruits and selects the self-directed employee (SDE). | The provider recruits, hires, and assigns agency staff. |
| Who directs the worker? | The individual or family directs day-to-day work and expectations. | The family gives input; the provider supervises its employee and is responsible for agency oversight. |
| Scheduling & call-outs | The individual or family builds the schedule and arranges backup coverage when someone calls out. | The provider is responsible for staffing its authorized service and managing call-outs and coverage within its workforce. |
| Hiring & employment paperwork | The family participates in hiring. The fiscal intermediary (FI) handles required employment and payroll administration; responsibilities differ by FI model. | The provider handles hiring paperwork and employment administration. |
| Background checks & drug screening | Required for SDEs. The FI facilitates required pre-employment checks and screening. | The provider coordinates required employee clearances and screening. |
| New-hire orientation | An Individual/Family-Developed Orientation is required. The family determines the content and trains the worker on the person’s needs, routines, preferences, and supports. | The provider is responsible for onboarding and orienting staff, including person-specific training before or as required for service delivery. |
| Mandatory DDD training | SDEs must complete mandated training. The family makes sure the worker completes requirements and understands person-specific expectations; the FI supports required processes. | The provider tracks and manages required training for its employees. |
| CPR / First Aid | Required. How the cost is handled depends on the FI model. | The provider ensures required certification and recertification for staff. |
| Payroll & taxes | Handled by the fiscal intermediary. | Handled by the provider. |
| Medicaid billing / claims | The FI manages the financial transaction using the authorized SDE billable rate. | The provider submits claims for delivered services. |
| Daily service documentation | Required. The SDE completes documentation; the individual, employer, or managing employer has a role in making sure it is completed and validated. | Required. The provider is responsible for its documentation systems, staff compliance, review, and record retention. |
| Performance concerns / discipline | The individual or family addresses performance and decides whether the worker should continue. Formal employment separation differs by FI model. | The provider handles supervision, discipline, corrective action, and termination of its employee. |
| Control over hourly wage | The individual or family chooses the SDE wage within DDD rules and the available budget. | The provider sets the employee’s wage. The family does not control what portion of the Medicaid rate becomes DSP pay. |
Part Two — Understanding the money
What the hourly numbers actually mean
Do not compare provider rates to SDE wages as if they are the same thing
A provider reimbursement rate is the amount Medicaid/DDD pays the agency for the service, and it supports the agency’s full cost of delivering it. An SDE wage is what the worker earns. The SDE billable rate charged to the person’s budget is calculated by the fiscal intermediary and includes the wage plus applicable employer burden.
2026 provider-led hourly reimbursement
| Service | 2026 DDD rate | Hourly equivalent |
|---|---|---|
| Community Based Supports — Base | $9.77 / 15 min | $39.08 / hour |
| Community Based Supports — Acuity | $14.99 / 15 min | $59.96 / hour |
| Individual Supports — Hourly Base | $9.85 / 15 min | $39.40 / hour |
| Individual Supports — Hourly Acuity | $15.16 / 15 min | $60.64 / hour |
Effective January 1, 2026. These are Medicaid/DDD provider reimbursement rates, not required DSP wages.
Self-directed employee wage
For services subject to DDD’s Reasonable & Customary wage rules, the standard SDE wage range generally runs from the prevailing minimum wage up to $25.00 per hour. A wage above $25 may be possible through DDD’s Enhanced Reasonable & Customary process when the applicable criteria are met.
| Question | What families should know |
|---|---|
| What the worker earns | The SDE wage selected by the individual or family, generally up to $25/hour under the standard R&C range. |
| What the budget is charged | The FI billable rate — not merely the wage. It can include employer taxes and other employer-related costs. |
| What a provider receives | The full DDD service reimbursement rate, from which the agency funds wages plus supervision, training, payroll, billing, insurance, compliance, recruiting, administration, coverage, and other operating costs. |
| Why the comparison matters | A lower SDE wage does not mean the same service “costs only $25.” It means the family is taking over management functions a provider would otherwise perform, while the FI handles defined fiscal and employment functions. |
A useful way to think about it
Provider-led services purchase both direct support and an agency infrastructure. Self-direction separates those pieces: the worker provides the direct support, the fiscal intermediary handles defined payroll and employer functions, and the individual or family manages many of the day-to-day staffing responsibilities.
Part Three — If you self-direct, you still have another choice
Acumen vs. Agency with Choice
Both models use a fiscal intermediary. The biggest difference is who serves as the legal employer, and how much employer infrastructure the FI provides.
| Acumen — VF/EA | Agency with Choice — Easterseals NJ | |
|---|---|---|
| DDD model | Vendor Fiscal/Employer Agent (VF/EA) | Agency with Choice (AWC) |
| Fiscal intermediary | Acumen | Easterseals NJ |
| Employer of record | The individual, or a family member or friend chosen by the individual, holds the EIN. | Easterseals NJ is employer of record; the individual or family serves as managing employer. |
| Monthly administrative fee | Paid by the State; not deducted as a PMPM fee from the individual’s budget. | The State contributes the VF/EA-equivalent amount; the remaining PMPM cost is deducted from the individual’s budget. |
| Payroll & taxes | Handled by Acumen. | Handled by Easterseals NJ. |
| Workers’ compensation | The State pays. | Included in the SDE service bill rate and paid through the individual’s budget. |
| Training / CPR / First Aid cost | Required; the employee is reimbursed through a state-funded stipend. | Required; cost covered by Easterseals NJ as employer. |
| Paid leave | Sick time only, earned at 1 hour per 30 hours worked. | PTO available based on hours and years worked for Easterseals NJ. |
| Employer-sponsored health insurance | Not available through this model. | Available for eligible employees working 30+ hours a week for Easterseals NJ. |
| Who approves timesheets? | The individual or employer of record. | The individual or managing employer. |
| Who recruits, chooses, and directs SDEs? | The individual or family. | The individual or family. |
| Who ends employment? | The individual or employer of record. | Easterseals NJ formally severs employment; the individual or family determines whether the worker continues providing their services. |
Agency with Choice does not become a traditional provider agency. The individual or family still recruits, chooses, directs, schedules, and approves time for SDEs.
Part Four — What the additional AWC fee pays for
Agency with Choice: added support, added budget cost
Families sometimes see the Agency with Choice monthly fee and ask, “Why would I pay more if I am still managing the worker?” The added cost reflects a different employment structure: Easterseals NJ is the employer of record and carries additional employer responsibilities and employee benefit infrastructure. It does not replace the family’s role as managing employer.
| AWC level | General description | Monthly | Annual |
|---|---|---|---|
| PMPM 1 | One or more SDEs working 0–40 hrs/week for the participant or Easterseals NJ; no health benefits elected. | $266.34 | $3,196.08 |
| PMPM 2 | One SDE works under 30 hrs/week for the participant but 30+ hrs/week for Easterseals NJ; no health benefits elected. | $493.98 | $5,927.76 |
| PMPM 3 | Health benefits elected: one SDE works 30+ hrs/week for the participant, or a qualifying multiple-SDE scenario. | $646.62 | $7,759.44 |
| PMPM 4 | Two or more SDEs work 30+ hrs/week for the participant and elect health benefits. | $987.82 | $11,853.84 |
The current DDD-posted AWC PMPM table is effective February 1, 2025. DDD notes that the table is guidance only, and that the Support Coordinator should confirm the applicable PMPM with the AWC fiscal intermediary.
What AWC adds compared with Acumen’s VF/EA model
| Added infrastructure | What it means |
|---|---|
| Employer of record | The family does not need to hold the employer EIN; Easterseals NJ assumes the formal employer-of-record role. |
| Formal employment separation | Easterseals NJ handles severing the worker’s employment. |
| Employee benefits infrastructure | Eligible workers can access employer-sponsored health insurance; PTO is available based on the AWC employment structure. |
| Training / certification expense | Required training and CPR/First Aid costs are covered by Easterseals NJ. |
| Workers’ compensation structure | The FI holds the workers’ compensation arrangement, with the cost reflected in the service bill rate. |
The trade-off
Acumen generally preserves more of the individual budget because DDD pays the VF/EA administrative fee — but the individual or family is the employer of record. Agency with Choice costs the individual budget more, but shifts the formal employer-of-record role and several employer responsibilities to Easterseals NJ.
Neither option eliminates the need for the family to actively manage the worker and the services.
Part Five — Questions to ask before choosing
Which structure fits your family?
| Think about | Ask yourself |
|---|---|
| Staffing | Do we already know who we want to hire? Are we comfortable recruiting new workers and finding backup coverage? |
| Management | Can someone reliably schedule staff, communicate expectations, approve time, address performance concerns, and follow up when documentation is missing? |
| Training | Are we prepared to provide a meaningful person-specific orientation and make sure the SDE understands health, safety, behavioral, communication, and daily support needs? |
| Budget | How many hours of support can the budget sustain under provider-led rates versus the SDE billable rate? What AWC PMPM fee would apply if we choose that model? |
| Employer role | Are we comfortable being the employer of record under Acumen, or would we rather have Easterseals NJ hold that role under AWC? |
| Benefits & retention | Would access to PTO or employer-sponsored health insurance make a meaningful difference in recruiting or retaining the SDE we want? |
| Mixing models | Would it make sense to self-direct some supports while using provider-led services for others, based on staffing needs, reliability, complexity, or family capacity? |
Self-direction does not have to be all-or-nothing
A family may use self-directed services where greater control is valuable, and provider-led services where agency infrastructure, backup staffing, clinical oversight, or reduced family management burden is more important. The right arrangement can change over time.
Official New Jersey resources
These are published by the Division of Developmental Disabilities and are the place to confirm anything in this guide:
- DDD Self-Direction Options and Education
- DDD Side-by-Side Comparison of SDE Models (February 2026)
- Agency with Choice PMPM Cost Table
- DDD Supports Program Policy Manual
- FY26 DSP & Supervisor Rate Increases (effective January 1, 2026)
- DDD Best Practice Guide
All are available on the NJ Division of Developmental Disabilities website (opens in a new tab).
Rates, policies, and fiscal intermediary requirements can change. Families should confirm current information with their Support Coordinator and the applicable fiscal intermediary before making budget or employment decisions. Rates verified September 2026.
Still weighing
your options?
If you would like help thinking through whether self-direction fits your family, or support getting set up once you have decided, I am glad to talk it through with you.
Book a Consultation