Self-Directed Program Enrollment

More than 1.5 million people self-directed the LTSS they receive, including veterans and Medicaid participants, in 2022 and 2023. This represents an 18 percent increase from 2019, or almost 300,000 more people. From 2019 to 2022–2023, 35 states saw an increase of self-directing participants per 1,000 adults with disabilities by ten percent or more, while just six saw a decrease of the same magnitude. South Dakota saw the largest increase – more than tenfold - from 1.6 to 17.1 percent of self-directing participants per 1,000 adults with disabilities.

On this page
Best State Performance
US Value

Compare State Data


The number of people receiving LTSS services through one of several self-directed programs per 1,000 people with any disability.  For the current years, the data were collected for the National Inventory of Self-Directed Programs by Applied Self-Direction from October 2022 through February 2023.  Reference year data were collected by Applied Self-Direction from April to August 2019.  Sources of data included state Medicaid waiver information, information from Financial Management Services providers, and telephone interviews with self-directed LTSS program administrators. The self-directed programs people might be enrolled in include Medicaid HCBS waivers (Medicaid program website:, state-funded programs and Veteran Directed Care (program website:  The number of people with disabilities is from the 2021 American Community Survey for the current year, and the 2018 American Community Survey for the reference year.  

Applied Self-Direction, The 2023 Self-Direction National Inventory: For the 2023 State Scorecard on Long-Term Services and Supports, February 2023 (to be published in late 2023)

US Census Bureau, ACS, American Community Survey (Washington, DC: US Census Bureau, 2018 and 021).  Census population data (all ages) from 2018 and 2021 American Community Survey 1-Year Estimates, Table B18101, Sex by Age by Disability Status, available at


See what’s new in this edition…how did your state do?
Explore the LTSS State Scorecard

Stay up to date with LTSS. Receive News and Trends in your Inbox.