Once your child is enrolled in Florida's iBudget waiver, you will hear about an option called CDC+, short for Consumer-Directed Care Plus. It lets a family manage part of the waiver budget directly: hiring workers, setting schedules and buying approved supports, instead of choosing only from enrolled waiver providers. For some families it is a lifeline; for others it is more paperwork than they want. This guide explains what CDC+ is, who can use it, how it works, and how to decide. It is based on APD's CDC+ pages, its CDC+ How-To Guide and Florida law as of October 2026. APD and your CDC+ consultant have the final word on the rules for your child.
What is CDC+?
APD describes Consumer Directed Care Plus as "an offering within APD's iBudget waiver that gives Floridians with developmental disabilities more control and flexibility over their care." People who choose it "become employers and manage their own supports, resources, and care" through a monthly budget.
The legal roots are in two statutes. Section 409.221, Florida Statutes, the Florida Consumer-Directed Care Act, says people enrolled in a Medicaid home and community-based waiver "and are able to direct their own care, or to designate an eligible representative, may choose to participate." Section 393.0662 refers to the Consumer-Directed Care Plus Program and directs the state to seek federal approval for a consumer-directed option for people with developmental disabilities. APD's How-To Guide gives the history: Florida started Consumer-Directed Care as a research project in 2000, renamed it CDC+ in 2004, and made it a permanent Medicaid state plan option under section 1915(j) of the Social Security Act in March 2008.
Who can use CDC+?
CDC+ is not a separate door into APD services. Your child must already be on the iBudget waiver. APD's How-To Guide lists these eligibility rules. The person must:
- be enrolled in the iBudget Florida waiver;
- live in their own home or the family home (self-directed personal assistance cannot be provided in a home owned, operated or controlled by an unrelated service provider); and
- not have been disenrolled from CDC+ before for mismanaging or misusing Medicaid funds. A representative who was disenrolled for that reason cannot take part in any role.
If your child is still on the pre-enrollment list, CDC+ is something to learn about now and consider later. See Florida's iBudget waiver and keeping your waitlist spot.
How does CDC+ work day to day?
APD's How-To Guide lists what a CDC+ consumer can do:
- Hire and manage workers. "People hired do not have to be enrolled as Medicaid waiver providers," and "employees can be friends or family members." The consumer decides how the job should be done and, with the consultant's guidance, what to pay.
- Write a monthly Purchasing Plan that describes how the month's funds will be spent on needs and goals in the support plan.
- Save for larger items through a savings section of the Purchasing Plan, for approved services or supports that are not bought every month.
- Buy supplies and supports such as consumable medical supplies from a vendor of their choice, home modifications, and accessible equipment or assistive technology, within program rules.
- Reconcile the monthly statement to make sure spending stays within the budget.
A minor child cannot run a budget, so parents usually act as the representative. APD's guide says a representative can be a family member or friend and "serves as the consumer's advocate." Section 409.221 describes the representative as an "uncompensated individual" designated to help manage the budget and services. Representatives must also pass the Readiness Review and sign a Representative Agreement.
Who helps us run it?
| Role | Who it is | What they do |
|---|---|---|
| Consumer | Your child, enrolled in iBudget | The person whose needs and goals the budget serves |
| Representative | Usually a parent or other unpaid family member or friend | Manages the budget, hires and supervises workers, makes decisions with and for the consumer |
| CDC+ consultant | A waiver support coordinator trained in CDC+ | Technical help and guidance; submits the application and enrollment packet |
| Fiscal/employer agent | APD's CDC+ payroll function | Processes timesheets and invoices, pays workers and handles employment tax filings |
| Directly hired employees and vendors | People and businesses you choose | Deliver the services in the Purchasing Plan; must pass required background screening |
APD's How-To Guide (version on APD's site, dated 2019) says the monthly CDC+ budget is figured from the iBudget cost plan with a discount so the program stays cost-neutral, and that APD charges a fee for payroll and tax work. Ask your consultant for the current figures, because they can change.
Background screening applies. Section 409.221 requires level 2 background screening for "all persons who render care," and APD's CDC+ background screening page says all CDC+ representatives, except self-representatives, must pass a level 2 background screening under sections 409.221 and 393.0655. As the employer of record, the consumer or representative registers in the state's Clearinghouse to screen prospective workers.
How do we enroll?
APD's How-To Guide lists four steps to become a CDC+ consumer:
- Attend New Participant Training (APD's state office schedules it).
- Pass a Readiness Review that shows the basic skills and knowledge to manage a CDC+ budget.
- Complete the application and enrollment documents. APD's Welcome Packet includes the application, a consultant selection tool, a representative agreement, an emergency back-up plan, IRS Forms 2678 and 8821, and a program consent form.
- Work with your CDC+ consultant on next steps. The consultant submits the packet; APD sends a Budget Authorization Form with the expected start date and budget.
Your support coordinator must tell you about CDC+. Section 393.0651(9) says the waiver support coordinator "shall inform" the client or family about the consumer-directed care program when developing or reviewing the support plan. Questions can go to the CDC+ Helpline at 1-866-761-7043.
Is CDC+ right for our family?
| Question | Traditional iBudget | CDC+ |
|---|---|---|
| Who provides services? | Enrolled waiver providers | Workers and vendors you choose, who do not have to be Medicaid waiver providers |
| Who is the employer? | The provider agency | The consumer, usually through a parent as representative |
| Scheduling and pay rates | Set by the provider within waiver rates | Set by you within the monthly budget and program rules |
| Paperwork | Mostly handled by providers and the support coordinator | Timesheets, Purchasing Plans, monthly reconciliation and screening steps |
| Who helps? | Support coordinator | CDC+ consultant and the fiscal/employer agent |
CDC+ tends to suit families who:
- live where enrolled providers are scarce, or need workers who speak their language;
- have a trusted person, such as a relative or neighbor, who knows the child well and can be hired;
- need flexible hours that agencies cannot staff; and
- are comfortable with budgets, records and being an employer.
It may be harder for families who are already stretched thin, as being an employer takes time. APD's guide asks every consumer to have an emergency back-up plan for when a worker cannot come or funds fall short.
Whether a particular relative, especially a parent of a minor child, can be paid for a particular service depends on CDC+ and waiver rules for that service. APD's guide notes special employment-tax treatment for some relatives, but tax treatment is not the same as permission. Ask your CDC+ consultant before you plan on it.
Where does ABA fit?
Behavior analysis services are an iBudget waiver service, but the waiver pays last. Section 393.0662(3) requires APD to confirm that a client has used Medicaid state plan services, school-based services, private insurance and other resources before iBudget funds pay. For most autistic children, ABA comes first from the family's health plan, TRICARE or another source. See who pays first for autism services.
Hope Center for Behavior Change is a private ABA provider, not an APD waiver provider. We work with Florida Blue, Aetna, Cigna, UMR, Personify Health and TRICARE East, and offer self-pay with a sliding scale. If your child has Medicaid, center policy does not allow self-pay at Hope Center; you can add marketplace or employer insurance, which we accept, and the sliding scale can help with your share. Our BCBAs train parents every week, which can help whoever supports your child at home use the same strategies. Contact us for a free consultation and benefits check or call 561-337-8865. For a wider view of programs, see benefits for an autistic child in Florida.