Introduction to Self-Directed Supports

How it works


Two adult individuals with developmental disabilities sit at a picnic table.

If you are eligible for services from Rhode Island’s Division of Developmental Disabilities (DDD) at the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) you can choose BHDDH funded Self-Directed Supports in place of, or in addition to, traditional agency directed services. Self-Directed Supports give you a way to have choice and control of the services and supports you need to live the life you want.  

Benefits of Self-Directed Supports

Self-directed supports allows for more flexibility and personal decision making. You, along with family members or people you know and trust, decide how to spend your Medicaid Long-Term Services and Supports (LTSS) dollars. You can choose your own staff and support providers and maybe get more “bang for your buck” with more of your dollars going directly to support your desired activities. Read about Self-directed Medicaid services at

Explore the information below to learn if Self-Directed Supports is the right option for you and how to get started. Before choosing Self-Directed Supports, consider talking with others who are using this service model. To learn more, watch What is Self-Direction, a recorded webinar (60:00 YouTube video) presented by RIPIN.

What You Need to Know

Your Role and Responsibilities

The benefits of choosing Self-Directed Supports are that you decide what you want to do, what help you will need and who will support you. When using Self-Directed Supports, you, along with family or others you trust, will:  

  1. Set your own goals. 
  2. Decide your own schedule and activities. 
  3. Choose the people and agencies that will support you.  

You will create an Individualized Support Plan to help plan your activities, schedule and how you will use your dollars to reach your goals. Participating in person-centered planning activities with family and people can be a good way to gather ideas, list your strengths and to talk about your interests and the supports that work best for you. Go to the Fiscal Intermediaries and Resources page for information and tools to help create a good plan.  

It is your responsibility to hire, train and supervise your staff – and fire them if you need to! If an employee quits or does not show up, you will need a backup plan. You decide how much to pay your staff based on your budget. You will sign time sheets and submit them to the fiscal intermediary for payment. A family member or trusted person you know can help you as needed. 

You can also choose to use some of your dollars to get services from a DDD/BHDDH agency or another agency that can help you to meet your goals.  


Steps to Get Started with Self-Directed Supports

  1. To get started with Self-Directed Supports, you must first be found eligible for adult services by the Division of Developmental Disabilities (DDD), Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH). It is recommended that you apply to DDD/BHDDH by age 17 or two years before you need adult services. 
  2. Once eligible, you will choose an agency to be your fiscal intermediary. Your fiscal intermediary will set you up as an employer and will manage the dollars approved for your services.   
  3. You will create an Individualized Self-Directed Plan and a budget. You will submit your plan and budget to DDD/BHDDH for approval before starting services. 
  4. Once you have an approval in writing, the next step is to find and hire staff.  

You will find information to help with each of these steps at Fiscal Intermediaries and Resources



You can find help in several places!

  • The fiscal intermediary (FI) you choose will set you up as an employer. The FI is primarily responsible for managing your authorized or approved budget for DDD/BHDDH services. 
  • You can ask family or friends to help design or write your plan. You can also hire an independent plan writer for a fee, and you can request a list of plan writers from your FI agency or ask others who they use.
  • Family or friends can also help recruit and supervise your staff, or you can use your dollars to hire someone to coordinate your staff schedule and supports.
  • Others using Self-Directed Supports can help answer questions and share resources. Consider attending SDS network meetings or joining the SDS LISTSERV to connect with them.
  • Some people pay a fee for support brokerage services to help with planning, budgeting and managing staff. These services are available from the following agencies:

Lazo Rhode Island 

BestLife RI

RI Self-Directed Coalition


Terms to know when using self-directed supports

  • Division of Developmental Disabilities (DDD): The division of Rhode Island's Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) that is responsible for planning, administering and providing supports and services for adults with developmental disabilities.  
  • DDD Social Case Worker: The person at DDD who will follow you as you engage with the DDD system. 
  • Support Intensity Scale (SIS): You will answer questions about how much help you need to be as independent as possible as an adult. After this interview, DD will let you know how much money they approve to pay for your supports or services.
  • Fiscal Intermediary:  A fiscal intermediary is an agency that manages the money approved by DDD. You do not receive any money directly from DDD. Your money is given to your fiscal intermediary, who will pay your staff wages and other bills. 
  • Individual Support Plan: The Individual Support Plan (ISP) is a written plan submitted to DDD for approval annually. The plan should include an overview of your current situation, your desired future, specific goals and support needs, resources required to achieve personal goals, and a budget that outlines exactly how you will spend your money from DDD.
  • Support Brokerage: A support broker is hired by you and takes all directions from you. A broker is a liaison between you and the agency or staff providing services. They help identify your needs, special requirements and resources. They also help to implement, monitor and support the goals in your Individualized Service Plan (ISP). This is an optional service paid for with your budget.