ALTCS Member-Directed Options

Member directed models or options allow members to have more control over how certain services are provided, including services like attendant care, personal care and housekeeping. The models are not a service, but rather define the way in which services are delivered. Member-directed options are available to most Arizona Long Term Care System (ALTCS) members who live in their own home. The options are not available to members who live in an alternative residential setting or nursing facility. ALTCS members or their representatives are encouraged to contact their case manager to learn more about and consider member-directed options.

Agency with Choice Resources

Section 1915 (k) of the Social Security Act allows states to provide community-based attendant supports and services to individuals with disabilities who require an institutional level of care at a 6% enhanced Federal match, so long as certain federal requirements of the program are met. AHCCCS is utilizing this opportunity to adopt a new member-direct option called "Agency with Choice."

Agency with Choice is a new member-directed option that will be available to home-based ALTCS members beginning on January 1, 2013. Under the Agency with Choice option, the provider agency and the member enter into a co-employment relationship and share employer-based responsibilities for the paid caregiver. The provider agency maintains the authority to hire and fire the caregiver and provide or arrange for the required minimum standardized training for the caregiver. The member, or their individual representative, may choose to assume one or more of the following employer-based responsibilities:

  • Recruit and select caregivers, including specifying the qualifications of the caregiver over and above the standard qualifications required by AHCCCS
  • Dismiss caregivers
  • Manage caregivers, including determining duties and schedules
  • Supervise caregivers
  • Training caregivers, including identifying special training needs

The Agency with Choice model is being developed in collaboration with a council comprised of ALTCS members, providers, community stakeholders and contractors, known as the Development and Implementation Council. The Council’s primary function is to work with AHCCCS to develop the State Plan Amendment that will be submitted to the Centers for Medicare and Medicaid Services, outlining the Agency with Choice member-directed model. Additionally, the Council will provide input on the programmatic changes AHCCCS will need to make in order to implement the new model, including policy and form changes.

The following are links to information and resources pertaining to AHCCCS' development work on the initiative. Additional information will be posted once it is made available. If you have any questions about the Agency with Choice member-directed model in general or the resources on this page, please contact Dara Johnson (Program Development Officer) at 602-417-4362 or

  • CMS Final Rules, 5/7/12 [PDF]
  • Final State Rules [PDF] | [RTF]
    On December 6, 2012, the final state rules were filed with the Arizona Secretary of State. The rules are effective January 1, 2013.
  • State Plan Amendment [PDF] | [RTF]
    On October 5, 2012, AHCCCS submitted a State Plan Amendment (SPA) to the Centers for Medicare and Medicaid Services outlining the Community First Choice, Agency with Choice, member-directed option.
  • Public Orientation Training
    On October 29, 2012, AHCCCS hosted an informational session for members of the community to learn about the proposed new member-directed option, Agency with Choice. Click on the link below for more information.
  • AHCCCS Member Communication
    Click on "Member Notice" for the latest communication regarding the new Agency with Choice, member-directed option. Click on "FAQs" for answers to common questions pertaining to Agency with Choice.
Council Meetings
Meeting Date Meeting Documents and Summary
March 24, 2011 March 2011 [PDF]
May 26, 2011 May 2011 [PDF]
October 13, 2011 October 2011 [PDF]
November 10, 2011 November 2011 [PDF]
December 08, 2011 December 2011 [PDF]
January 12, 2012 January 2012 [PDF]
March 08, 2012 March 2012 [PDF]
April 27, 2012 April 2012 [PDF]
June 14, 2012 June 2012 [PDF]
July 12, 2012 July 2012 [PDF]
September 13, 2012 September 2012 [PDF]
October 11, 2012 October 2012 [PDF]

Self Directed Attendant Care (SDAC) Resources

Self Directed Attendant Care (SDAC) is a member-directed option that has been available to members since 2008. Under the SDAC option, the member or member’s legal guardian serves as the legal employer of the paid caregiver and assumes all employer-based responsibilities. The member or member’s legal guardian is supported by a Fiscal Employer Agent that takes care of the taxes, payroll withholding and paychecks for the caregiver.


Additional Information & Brochure

SDAC Brochure [PDF] | [RTF]

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