Self-direction empowers individuals. It gives them control over their care and promotes independence. It helps people avoid institutional care and stay in familiar home and community settings, where they get the support they need. In general, self-direction programs can support people at a lower cost than traditional care facilities. At the same time, they can offer more personalized care. Studies show that self-direction can improve quality of life.  Self-direction participants have reported more satisfaction with services and fewer unmet needs. Overall, their health outcomes are as good or better than those who get traditional care. Plus, some studies have shown that their families experience less stress and improved dynamics. 

Yes. Since becoming the fiscal intermediary (FI) for Connecticut in 2024, GT has worked with departments to support self-direction success. Programs are growing. In the past two years alone, participation in Connecticut’s self-direction programs has grown by more than 2,000 participants. These programs are thriving, largely thanks to more than 20,000 personal care attendants (PCAs) statewide who provide care. 

The process starts by working with the state to learn if the person is eligible for Medicaid and meet the criteria for long-term services and supports. Once a person is eligible, they work with a case manager and program to build a plan around their needs. It’s called a person-centered plan, and it includes an authorized Medicaid budget for goods and services. The next step in the self-direction journey is getting connected with an FI, like GT. Our role is to make sure people in self-direction are supported in their employer duties. Following program and Medicaid rules, we help with details like paperwork, background checks, payroll taxes, and paying workers on behalf of program participants. 

With self-direction, the person receiving care is the employer. They choose who provides care, including when and where. They may also control how to spend a budget authorized by their state Medicaid program. They can use approved dollars to pay people who support them. They may also be able to buy goods and services that help make day-to-day life more manageable. 

Self-direction is built on person-centered planning. Each participant works with their care team and the state department administering their program, such as the Department of Social Services (DSS). Together, they create a care plan that sets approved service hours and budgets. Within those limits, participants choose, schedule, and supervise their caregivers.  

GT created the GT Portal to support people who use self-direction. Participants will find everything they need to manage self-direction and make decisions with good information in the GT Portal. The GT Portal has updated budget information. They can easily see what was authorized, what was used, and what is left. Participants can also review and approve timesheets and find forms, documents, and other resources for self-direction in the GT Portal. They can sign in from their computer, smartphone, or tablet.

The fiscal intermediary (FI) supports self-direction by managing paperwork, payroll taxes, and caregiver payments. Payments are only made if they are approved by the participant employer and authorized by the state. The FI makes sure that programs operate safely, efficiently, and according to state and federal rules. These safeguards are in place to protect participants, the caregivers who support them, and the programs.

Connecticut’s self-directed programs have an extensive system of oversight and accountability. Current contracts have rigorous performance standards. They also have reporting requirements and “cure” processes that help with accountability. 

GT follows a payroll schedule set by the state. PCAs track their hours in an app, and their participant employer must approve the hours and submit them to GT Independence each week. The amount must not be more than what is in the participant’s budget authorized by the state. These fiscal guardrails ensure checks and balances within the state’s Medicaid system. They help protect self-direction programs for everyone. 

For GT, timely and accurate payroll is one of the most important things we do. In Connecticut alone, we process hundreds of thousands of payment transactions each month. These are payments for Connecticut PCAs and vendors, and our accuracy rates are more than 99%.

Since becoming the FI for Connecticut in 2024, GT has helped grow a stronger program. We have processed hundreds of thousands of payment transactions for Connecticut PCAs and vendors each month. Our accuracy rates are higher than 99%. We’ve invested in budget and authorization tools for better planning. We’ve also improved payroll and reporting systems. Plus, we added more people to our dedicated customer service staff. We have listened to stakeholders and turned their feedback into action, and the program is thriving. In the past two years alone, participation in Connecticut’s self-direction programs has grown by more than 2,000. 

At GT, our mission is to help people live the life of their choosing, regardless of age or ability. Our company started in 2004 after setting up self-direction for a family member. Self-direction has been our passion and become our area of expertise. It is all we do, and many of our staff support loved ones who self-direct. GT manages more than 150 self-direction contracts across 22 states and the District of Columbia. We help define industry best practices and know how to apply them.  

GT is committed to the long-term success of self-direction in Connecticut. We work with programs across the country. That gives us experience with all types and sizes of self-direction models. We’ve helped define industry best practices and apply them. We are committed to working with the state to continue to identify how systems can be strengthened. That’s because we want to be sure the self-direction programs work well and over the long-term.

We’ve identified three key areas to tackle together. First, making clear and consistent written guidelines available and accessible to everyone. Second, budget reports are only meaningful if they include timely, accurate data. These numbers help participants know if they have funds to pay PCAs for critical work. We are working with the departments to improve the information we receive. We need standardized, complete, and accurate data that can be processed quickly. Finally, we ask SEIU 1199NE, PCAs and caregivers, participants and their families, and Connecticut departments to join us in an advisory board where all stakeholders are represented. We can identify areas for improvement and sound solutions.