What is Self-Determination?

Self-Determination is a way to make meaningful decisions about the way you live your life. Self-Determination lets you choose who provides the services and supports identified in your person-centered plan.

Self-Determination is not a program, but a different path for delivering Medicaid services. The Self-Determination lifestyle gives consumers and guardians more control over the use of the Medicaid dollars that are set aside for consumer care. With Self-Determination the consumer/guardian is able to look at the services they are already receiving or services that they may need and decide if there is a different or more creative way, of meeting the consumer’s needs.

Five Principles of Self-Determination 

  1. Freedom - The ability to plan a life rather then, purchase a program. Freedom is a life surrounded by the supports and services that individuals need and want.
  2. Support - To organize resources in ways that are life enhancing and meaningful to the individual with a disability.
  3. Responsibility - The wise use of public dollars (Medicaid) and recognition of the contribution that individuals with disabilities make to their communities.
  4. Authority - The ability to control a sum of dollars within a budget, in order to purchase needed supports for individuals lives.
  5. Confirmation - The important role that individuals play as their own self-advocate.

Who can participate?

Any individual receiving services from Saginaw County Community Mental Health Authority (SCCMHA), whether you are working towards recovery or towards increased independence, may participate in self-determination.

How does it work?

First, you contact your SCCMHA worker and let them know of your level of interest. Then you can decide to either have a meeting with the Self-Determination Coordinator to learn more about the Self-Determination lifestyle or proceed to developing an individual plan of supports and services using the Person-Centered Planning (PCP) process with help from the people you choose. During this meeting, you and your PCP team will look at what is available to you from your community, your family and your friends. You and your PCP team will develop a budget to determine the cost of services.

An individual budget shows how much the supports and services outlined in the Person-Centered Plan will cost. It is the individual's job to stay within their budget.

  • A budget is created with you, your support network, your Suppports Coordinator/Case Manager and the Self Determination Coordinator based on the consumer’s needs in their Person-Centered Plan (PCP).
  • The number of service hours is determined and based upon the needs documented in your PCP.
  • An outline of what your staff will do for you is documented in your PCP, and in a job description for your staff.
  • You decide on what is a fair wage to pay your staff, for the work that you are asking them to do.
  • You find the staff that will work best with you or the self determination coordinator can assist you. (You may not hire your guardian or a spouse.)
  • You are expected to stay within your budget as documented in your PCP and when any changes occur you are expected to let the Self Determination Coordinator know.
  • You are the boss of the staff that you hire.
  • You will be asked to sign your staff’s time cards.

Then what happens?

After you set your budget with your PCP team, you will work with a Fiscal Intermediary who helps you manage your money, pays your staff, as well as assists you with job related issues (hiring staff, keeping track of timecards placing ads in the paper for staff, etc.)

At no time can Medicaid dollars go directly to a consumer or their guardian, therefore a fiscal intermediary is used to act as the employer's financial agent. The fiscal intermediary receives funds from SCCMHA as outlined in the individual budget, then makes payments as authorized to providers, such as a CLS worker.

Does the fiscal intermediary make all the decisions?

No, they do not. You choose who will be hired to help you. You are the employer. You know best what works well for you and what kind of staff you will work best with. You can hire people you already know (as long as it is not your guardian or spouse), or you can ask SCCMHA to put you in contact with a qualified provider.

Remember the people you choose must be able to give you the support you need.

What if the person I hire is not doing a good job?

You can fire anyone who is not doing a good job providing the supports they were hired to do. Your fiscal intermediary and the Self-Determination Coordinator can assist in this process.

How do I know if Self-Determination is right for me?

If you want to be more independent in choosing who is hired to work with you, where you live, and how you spend your free time, then contact your support coordinator or case manager today to talk about Self-Determination.

For more information....

For more information contact the Self-Determination department at 989-272-7182 or self.determination@sccmha.org.

To learn more about Self-Determination, visit The Center for Self-Determination.  

Housing Arrangements

Here are some examples of creative housing arrangements:

  • Rent an apartment with two rooms and have a housemate to share the costs with and who can be a support to one another. 
  • Rent or buy a home and have a live-in staff who provides care in return for free or drastically reduced rent.
  • Rent or buy a duplex and have the next door duplex owner provide monitoring and supervision. (monitors, phones, pagers, etc)
  • Have persons with similar needs rent rooms in a home from a Landlord and share staffing.
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