Participant Direction promotes independence by allowing individuals or their representatives to make decisions about the services and supports they receive from Medicaid Home and Community-Based Waivers. Georgia allows Participant Direction in the NOW/COMP waiver.



star Participant Direction is a Service Delivery Option

Service Delivery refers to the method that is used to obtain the services. Individuals can choose to receive services using the Traditional Provider Model or by Participant Direction.


Traditional Model: Services are provided by a Medicaid approved company that is responsible for providing the necessary supports and services including hiring and paying employees. The company charges a fee for their services (usually a percentage of the cost of the services) which is taken from the budgeted allocation of the waiver. The company will pay for your services and  bill Medicaid for reimbursement


Participant Direction: You are the employer and are responsible for recruiting, hiring and training employees. You determine how much you will pay for services and which vendors you will use for supplies and other goods and services. You are responsible for managing your budget and submitting invoices and/or timesheets for services to a fiscal intermediary. The fiscal intermediary pays for your services and then bills Medicaid for reimbursement.


starWho can Participant Direct?

In Georgia, Participant Direction is an option for individuals receiving the NOW/COMP waiver and who live in their own home or in the home of a family member. Participant Direction is not available to individuals who live in a residential facility, host home or a personal care home.


In addition to the individual with the waiver themself, a legal representative of the participant or anyone that the individual chooses (if the individual is over 21) can direct the services.


It is important that whoever directs the services be able to understand and perform the tasks required to manage and supervise employees. In addition, he/she should be able to complete all required timesheets and invoices and manage the budget.

starGetting Started

The first step to getting started with Participation Direction is to contact your NOW/COMP waiver support coordinator who will assist you with the following steps: 1) Contact a fiscal agent to manage your waiver funds; 2) Complete enrollment forms for processing and approval; 3) Recruit, hire and train staff; 4) Select vendors for other services.


starSupport Coordination

Support Coordination is a required service for all NOW/Comp waiver participants. Support Coordinators identify, coordinate, and oversee the delivery of services. Learn more about Support Coordination and the NOW/COMP waiver. The DBHDD Division of Developmental Disabilities contracts with the following provider agencies to deliver these services to NOW/COMP recipients:

Columbus Community Services

Creative Consulting Services

Georgia Support Services

Professional Case Management (PCSA)

Benchmark Human Services


starFiscal Agents

Financial Support Services or Fiscal Agents are a required service of Participant Direction. They are responsible for managing your waiver funds by performing payroll responsibilities, ensuring employee papperwork is complete, withholding state and federal taxes, and tracking and monitoring your budget. The fee for these services are set by Medicaid and are a part of the individual's budget. Below are the current approved fiscal agents in Georgia:

Acumen Fiscal Agent

PCG Public Partnership

Continuum Fiscal Services


starCheck out these Additional Resources

Download the DBHDD Participant Direction Brochure

See the List of Participant Directed Waiver Services

Download the P2P/DBHDD Participant Direction Fact Sheet

Are you interested in connecting, learning and suppporting other individuals and families that Participant Direct? Check out these Facebook Groups:

NOW/COMP Waiver (Questions/Support)