Consumer-Directed vs. Agency-Directed

In Virginia, individuals approved for a Medicaid Waiver have the right to select which model of service delivery they would like to utilize: Consumer-Directed or Agency-Directed. The individual has the right to receive services in the community. It is the individual’s choice whether to receive services in the community through a Medicaid Waiver or other placement. The individual has the right to choose their Waiver service providers and to change providers. 

It is the individual’s right to choose or change a provider. Individuals will want to be comfortable with the model of service and provider that will be assisting them with personal needs and support. 


  • Consumer-Directed is a model of service delivery for which the individual or the individual’s Employer of Record, as appropriate, shall be responsible for hiring, training, supervising, and firing of the attendant who provides the direct support or specific services covered by DMAS and whose wages are paid by DMAS through its fiscal agent.


  • Model of service delivery where an agency is responsible for providing direct support staff, for maintaining an individual’s records, and for scheduling the dates and times of the direct support staff’s presence in the individual’s home and community for personal and respite care.

Contact your local DSS for a comprehensive list of providers.

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