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Consumer-Directed Services VS. Agency Directed Care
What is the difference ?

Once approved for the Medicaid Waiver in Virginia,  people are able to choose between two models of service delivery;

Consumer Directed (like us), or Agency Directed. The individual receiving services will want to be comfortable and knowledgable with both the model of service & the provider assisting them. You should have gotten a list from your local DSS of providers to choose from. At Toddlers To Grandparents, we want all of our potential clients to be informed before selecting a model.  Below is a description of both models.

Consumer-Directed (Toddlers To Grandparents is an option)

  • Consumer-Directed is a model of service delivery for which the person/individual (the consumer) or the individual’s EOR/Employer Of Record "directs the services" by selecting, hiring, training, supervising, and firing the attendant/aide who provides the direct support or specific services covered by DMAS and whose wages are paid by DMAS through it's fiscal agent.

    • Consumer-Directed receives assistance from a Service Facilitator. This SF assists the individual with all the pieces of the puzzle by making the necessary calls and submitting paperwork. This SF makes sure that the supports listed in the individual's  plan of care are developed and monitored, while allowing for the consumer to have complete control of the support in their home.  


  • Model of service delivery where an agency is responsible for providing direct support staff, for maintaining a person’s records, and for scheduling the dates and times of the direct support staff’s presence in the person’s home and community for personal and respite care. Short-term care for a child or adult that allows the primary caregiver relief. 

OK, I choose Consumer-Directed Services, what’s next?


Toddlers To Grandparents will set you up with one of intake specialists on our Service Facilitator (SF) team to conduct an Initial Comprehensive Visit and also the Initial Comprehensive Training.  Your SF will explain how the entire world of consumer directed services works!


More specifically, a SF does the following:


  • Ongoing reviews and annual assessments that you and DMAS (Department of Medical Assistance) require.

  • Makes sure that you are approved and preauthorized for all of the supports you need and that these supports are on your plan of care.

  • Provides you with the DMAS Consumer-Directed Employer Manual.

  • Sets you or your designated individual up as the Employer of Record (EOR) with Public Partnerships (PPL).

  • Teaches you the tasks required of an employer.  This includes how to fill out required paperwork for your attendant and complete timesheets to get your attendant paid.

  • Submission annually for re-authorization of attendant hours.

After the initial training, your SF continues to work for you behind the scenes making sure your authorizations are in place and things are running smoothly.


While we are busy with the above, you can begin hiring and scheduling your attendants!


Your SF cannot be you, your spouse, your parent (if you are a minor) or a family member or caregiver who is also the CD Employer of Record.

After your initial visit is complete .. 

You will meet with your Service Facilitator (SF) on a regular basis to complete a routine visit to supervise the service plan.


For families whom have a child with a disability, the daily routine is challenging and exhausting.


For our aging parents, retaining control over their lives is an ongoing challenge.



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