Consumer direction is an approach of service delivery in which the individual receiving the service is in control. In a consumer-directed system, the person receiving the service is considered “the boss” and is able to decide who they will work with, and how they will work with them. The degree to which consumer direction is implemented depends on the policies of the state programs. This means that some states are very flexible in how they are able to have programs be consumer-directed. Some programs will allow the individual receiving services hire, train and pay the staff that will be working for them; they can also fire staff if that person is not meeting their needs. Other states require that staff working in a particular capacity be trained and meet requirements that they have outlined, which can be limiting to the broadest definition of consumer direction occurring. The good thing is that people receiving services can be assured that the person they are working with has met a minimum set of criteria and skills. It does mean, though, that if you want a certain person to work with you who hasn’t met those criteria, it will be hard for them to do so and still be paid for through the state Medicaid program unless they are working for a Medicaid enrolled provider agency. Regardless of how broad or narrow the state’s definition of consumer direction is, the individual receiving the service is able to decide who they work with and how they want services to be provided.