Key Findings of the 2023 Self-Direction National Inventory

The 2023 National Inventory of Self-Directed Long-Term Services and Supports (LTSS) and the 2023 LTSS State Scorecard were recently released through a collaboration between AARP, The Commonwealth Fund, The John A. Hartford Foundation, and the Scan Foundation. This extensive inventory overviews publicly funded self-directed LTSS over the last three years. It explores data such as funding sources, populations served, and recent trends influencing the LTSS framework. Join Acumen Fiscal Agent as we drill down and elaborate on a few key points discovered in this year’s inventory.

Data Collection Methods

Information for this year’s inventory was collected through various methods. Data regarding self-direction programs was gathered between October 2022 and February 2023, and a comprehensive review of state-run self-directed processes and systems was conducted. (This included all 50 states and the District of Columbia.) State program administrators, with the assistance of state financial management services and enrollment estimates, provided self-directed enrollment information.

Key Findings

The 2023 Inventory focuses on self-direction enrollment as a meaningful measure of growth. The key findings below demonstrate how self-direction enrollment has changed since the 2019 Inventory.

• There are 1,520,267 individuals self-directing nationwide, representing a 23% increase since 2019.
• 90% of states use the Medicaid 1915(c) waiver, the most commonly used funding source for self-direction.
• Medicaid authorities are increasingly administering self-direction including the 1915(k) State Plan Option and the 1915(i) State Plan Option.
• Usage of the 1915(k) State Plan Option grew from 14% in 2019 to 16% in 2023.
• The 1915(i) State Option Plan increased from four percent in 2019 to eight percent in 2023.
• Most states provide self-direction options for adults over 65, adults with physical disabilities, and adults with intellectual and developmental disabilities (I/DD).
• Self-direction is not as available for other populations outside the above demographics.
• 92% of all states offer self-direction for adults with I/DD.
• Accessibility of self-directed programs does not guarantee higher state enrollments, revealing that further advocacy for equal access is needed.

Fiscal Agent Solutions for Self-Directed Populations

As one of the oldest fiscal agent services in the country, Acumen specializes in working with self-directed individuals who receive home and community-based services. We collaborate with each participant, their employee, and the case manager to administer their fiscal intermediary responsibilities. Learn more about our self-directed solutions, funding partners, and fiscal management services available in your state, or contact us at (877) 211-3738.