If your family member has been approved for a Minnesota disability waiver, you will probably be asked an early question: do you want to run the services yourself, or have an agency do it? The self-directed route is called Consumer-Directed Community Supports (CDCS). The agency route usually means a provider licensed under Minnesota Chapter 245D.
Neither is better in general. They trade control for convenience. This guide lays out what each one asks of you so you can choose with open eyes.
What CDCS is
CDCS is a self-directed option. Instead of an agency assigning staff and setting the schedule, the person (or a family member or representative acting for them) builds a plan and a budget, then hires and manages the people who provide support. According to the Minnesota Department of Human Services, a person must be assessed as eligible for one of these programs to choose CDCS: Alternative Care, Brain Injury (BI), Community Alternative Care (CAC), CADI, Developmental Disabilities (DD) or Elderly Waiver.
Key features, per DHS:
- The budget is set from the person's assessment results using state criteria, and your county or other lead agency explains it with the assessment results.
- The person acts as the employer, with help from a financial management services provider, and takes on hiring, training and supervising workers.
- Workers can be people you know, such as family, friends and neighbors.
- Besides staffing, CDCS can pay for things like non-traditional supports, special therapies, assistive technology, supplies and home or vehicle modifications.
Ramsey County's CDCS guide to DHS policy adds two rules families often ask about:
- A spouse or the parent of a minor can be paid only for personal assistance services.
- Everyone paid through the plan must pass a background study through the DHS Licensing Division.
What an agency provider is
A 245D-licensed agency employs, trains and schedules its own staff and is responsible for meeting state licensing standards for the services it delivers. Services such as respite care, individualized home supports and integrated community supports are delivered this way. If a worker is sick, the agency is the one that finds coverage.
The real differences
Who finds and manages staff. - CDCS: you recruit, hire, schedule and replace workers. - Agency: the provider does, and you give feedback.
Who does the paperwork. - CDCS: you or your representative help write the plan, keep records and work with the financial management services provider. - Agency: the provider handles documentation under its license.
Flexibility. - CDCS: more room to buy goods and supports in ways that fit the person's life, within the rules of the plan. - Agency: services follow what is authorized on the support plan and the provider's license.
When someone is out. - CDCS: you need a backup plan. - Agency: the agency is expected to cover shifts.
Training and oversight. - CDCS: you decide how much training your workers need, within the plan's requirements. - Agency: staff supervision, orientation and annual training are required of the licensed provider. See Minn. Stat. 245D.09.
You may not have to pick only one
Ramsey County's CDCS guide says a CDCS plan can include traditional waiver services as well as services you design yourself. It also says that if you get staff through an agency other than your financial management services provider, that agency must be a licensed 245D provider or properly enrolled with DHS, and you should talk with your case manager before setting it up. Whether that works in your case depends on your waiver and your county, so ask your case manager directly.
A short way to decide
CDCS tends to suit families who:
- already have trusted people who could work as paid support;
- have the time and willingness to be an employer;
- want to shape the schedule closely around the person's routines.
An agency tends to suit families who:
- want staffing, training and backup coverage handled for them;
- are already stretched thin as caregivers;
- need overnight or round-the-clock support that is hard to cover with a few individual workers.
Be honest about your own capacity. Being an employer is real work. If you are unsure, DHS offers a training called CDCS: Is it right for you?, linked from its CDCS page. If you later want to change providers, see our guide to changing waiver providers.
Questions to ask your case manager
- Is CDCS available on my family member's waiver, and what would the budget be?
- Can I use part of the budget for an agency service?
- Who would be the financial management services provider, and what does it handle?
- If I start with CDCS and it is too much, how do I switch, and how long does it take?
- If I choose an agency, how do we compare providers? Our list of questions to ask a 245D provider can help.
If you are not yet approved for a waiver, start with how to apply for a disability waiver in Minnesota and what to expect at a MnCHOICES assessment.
Talking it through with Midway Homes
Midway Homes Adult Care LLC is a Minnesota 245D-licensed provider in St. Paul, so we are an agency option and we are open about that. If CDCS is the better fit for your family, we will say so. Call 612-416-8555 and we will talk through what each route would look like for your family member. We serve Ramsey, Hennepin, Dakota, Scott, Washington, Chisago and Pine counties.
Eligibility, budgets and who can be paid are decided by your county or lead agency under state rules, so please confirm the details with your case manager before you decide.