Self-directed care is when an individual with a functional disability hires a personal aide to perform a manual function related to health care that the individual would otherwise perform for themselves if it were not for their disability.  The personal aide may work privately or with Medicaid clients through a contract with the Department of Social and Health Services (DSHS).  Personal aides that serve Medicaid clients are individual providers (IPs) and are required to register with DSHS.  There are about 1200 Medicaid clients self-directing their care and 47,000 IPs.  Not all IPs provide self-directed care.

In 2018, the Legislature passed ESSB 6199 which directed DSHS to implement a Consumer Directed Employer (CDE) program.  Under the CDE, IPs are employed by the CDE rather than contracted with DSHS.   DSHS began transitioning IPs to the CDE in 2021, and expects the CDE program will be fully implemented in 2022.

The requirements for personal aides who work as IPs to register and contract with DSHS are removed.   The role of a personal aide is to act at the direction of an adult person with a functional disability to assist with the physical performance of health care tasks.  It is specified that the exemption from health profession licensing for personal aides providing health care tasks does not exempt an IP from becoming certified as a home care aide.