Hawaii Self-Directed Care for Adults with Disabilities

What Self-Directed Care Means in Hawaii

In a consumer-directed arrangement, control shifts from the provider agency to the individual and their family. Instead of a waiver provider assigning a direct support professional and setting the schedule, your child (or their representative) hires, trains, schedules, and manages their own support workers within the authorized ISP budget.

For families frustrated by high DSP turnover, inflexible agency scheduling, or the neighbor island provider shortage, self-direction offers a practical alternative that keeps the same waiver funding but removes the middleman.

How It Works Under the I/DD Waiver

Hawaii's Medicaid I/DD Waiver includes provisions for consumer-directed services, where the participant or their authorized representative acts as the employer of record for personal assistance workers. The DDD case manager still develops the ISP and authorizes the service budget, but the family controls how those hours are used.

The key operational steps:

1. Request self-direction during ISP planning. Tell your case manager that you want to direct your child's personal assistance services rather than contracting with an agency.

2. Select a Fiscal Management Service (FMS). The FMS handles payroll, tax withholding, workers' compensation, and Medicaid billing on your behalf. You manage the schedule and workers; the FMS manages the paperwork.

3. Recruit and hire workers. Recruit workers through the approved process. Ask the FMS or case manager which relatives and other workers qualify and what screening is required.

4. Manage the budget. Your authorized budget is set by the ISP based on the SIS-A assessment. You decide how to allocate hours across the week and which workers to assign to which shifts.

Advantages for Neighbor Island Families

Self-direction is especially valuable on the neighbor islands, where the provider shortage means families can wait months after waiver approval for an agency to assign a DSP. With self-direction, you can recruit someone from your own community — a family friend, a college student, a retiree — subject to the program's worker-qualification and onboarding requirements.

If your hired worker and your child are both on the same neighbor island, there is no inter-island travel for that worker.

Limitations to Know

The specific services and worker arrangements available for self-direction depend on the authorized waiver services; confirm them with the case manager before hiring.

Managing staff is real work. You're responsible for scheduling coverage during worker sick days and vacations, resolving conflicts, and ensuring services are delivered consistently. Some families find this empowering; others find it exhausting on top of everything else they're managing.

Getting Started

If your child is already enrolled in the I/DD Waiver and receiving agency-directed services, you can request a transition to self-direction at any ISP review meeting. If your child is newly enrolling, request it during the initial ISP development.

The Hawaii SSI at 18 & Adult Disability Benefits Guide includes a self-directed care planning worksheet that helps you calculate the hourly rate you can offer based on your authorized budget, recruit effectively, and set up the FMS relationship.

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