The whole thing in one table
| Support Broker | Care Manager | Fiscal Intermediary (FI) | |
|---|---|---|---|
| Works for | You — paid from your self-directed budget | A Care Coordination Organization (CCO) | An agency you choose |
| Owns which document | The Self-Direction plan and budget | The Life Plan | Payroll, timesheets, monthly statements |
| Core job | Turn what you need into a budget OPWDD will approve, then keep it working | Coordinate all your services and record valued outcomes and safeguards | Be the employer of record and move the money legally |
| Hires your staff? | Helps you recruit and interview | No | Yes — employer of record. Runs background checks, payroll, required training |
| Approves your budget? | No — writes and submits it | No — must ensure the Life Plan lists your self-directed services | No — tracks spending against it |
| In your Circle of Support? | Yes — required member | Yes — required member | Not required |
| Can you change them? | Yes | Yes — and you can change CCO | Yes, though staff must re-clear |
| Can they hold another role for you? | No — cannot provide any other HCBS waiver service to you, and cannot be your Care Manager | No — cannot be your Support Broker | Separate agency function |
The one sentence version
The Care Manager writes down what matters. The Broker turns that into a costed plan. The Fiscal Intermediary pays for it and takes on the legal risk of employing people.
Who do I call about…
| The problem | Call | Why |
|---|---|---|
| A staff member's paycheque is wrong | Fiscal Intermediary | They run payroll and are the employer of record. |
| We want to add a community class to the budget | Support Broker | It is a budget change; they write the justification and the amendment. |
| Our Life Plan does not mention self-direction | Care Manager | They own the Life Plan and must ensure it lists your self-directed services. |
| A new hire cannot start — clearance is stuck | Fiscal Intermediary | They run background checks and onboarding. |
| We have run out of Community Habilitation hours in March | Support Broker | That is a budget amendment conversation, and possibly a planning one. |
| We want to add a day programme alongside self-direction | Care Manager | Coordinating services across providers is their job. |
| The Liaison has questions about our budget | Support Broker | They are the intermediary with the DDRO. |
| We are moving to another county | Care Manager first, then Broker | Region, CCO and possibly DDRO all change. |
| We think we are being billed for brokerage we did not get | Ask the broker, then the FI | The broker must document start and stop times; the FI holds the claim records. |
Where the handoffs go wrong
The Life Plan and the budget drift apart
The Life Plan is supposed to drive the self-directed plan — the valued outcomes in it are what the budget is justifying. When the Care Manager updates the Life Plan without telling the broker, or the broker amends the budget without telling the Care Manager, you end up at renewal with two documents that describe different lives. Fix it by insisting they are both in the same Circle of Support meeting at least twice a year. Both are required members, so this is not a favour you are asking.
Everyone assumes someone else told you
Authorization renewals, FI policy changes, new OPWDD guidance — each of the three assumes one of the others passed it on. Ask each of them, at every meeting, the same blunt question: is there anything coming that will change what we can do?
The FI is treated as an obstacle rather than a source
Fiscal Intermediaries see hundreds of budgets. They know which justifications survive review and which categories cause trouble. Families who treat their FI as a payroll vendor miss that. Ask them what they see going wrong most often.
One thing worth knowing about changing Fiscal Intermediary
There is no central background clearance across FIs. If you switch, staff cleared through your old Fiscal Intermediary generally have to go through the process again with the new one — fingerprinting included. Plan for a gap, or you will discover it the week your support disappears.
Questions families actually ask
Can the same person be my Support Broker and my Care Manager?
No, explicitly. OPWDD guidance states that a person's Support Broker cannot be their Care Manager, and cannot provide them any other HCBS waiver service either. Both are required members of the Circle of Support — the model assumes two people.
Does the Fiscal Intermediary decide what I can spend money on?
No, but they will refuse to pay for something outside your approved budget or outside OPWDD rules, because they carry the compliance risk. If the FI says no, the fix is usually a budget amendment through your broker rather than an argument with the FI.
Who is my staff member's actual employer?
The Fiscal Intermediary is the employer of record. You select and conditionally hire, but the FI verifies employment eligibility, runs background checks, delivers required training, and processes payroll. That distinction matters a great deal if there is ever a dispute.
Can I keep my Care Manager if I change CCO?
Generally no — Care Managers are employed by the CCO. If the relationship with the individual Care Manager is the thing you value, ask about changing Care Manager within the same CCO first.
Where this comes from
Written from the OPWDD source documents below and reviewed against them on 23 September 2026. OPWDD policy and figures change; confirm anything that affects a decision with your Care Manager or your DDRO Self-Direction Liaison before acting on it.
Keep reading
Not sure where you are in this process?
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