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Just over 1 million people were enrolled in Medicaid-funded and Veteran-Directed Home- and Community-Based Services self-directed programs in 2016.  Evidence shows that self-direction is an

effective way to provide long-term services and supports (LTSS).   Although enrollment increased by more than 40 percent since 2011, nationally, fewer than 27 out of every 1,000 people with

any disability were self-directing their LTSS.   This paper describes how four states (Texas, Iowa, Wisconsin, and Florida) used innovative strategies to develop and expand self-directed

services programs, coordinate and personalize service options, promote stakeholder engagement and outreach, and implement training programs to expand opportunities for individuals to

self-direct their LTSS.  This paper also includes a toolkit of self-directed program resources that can be used for training, education, collaboration, and replication.  These tools are

offered as a guide for states seeking to develop, improve, or expand their own self-directed LTSS programs.    This paper is the fourth in a series of innovative and promising practices

reports. This series is a new feature of the 3rd edition of the Long-Term Services and Supports State Scorecard published in 2017. The _Scorecard_—written by the AARP Public Policy Institute

and funded by The SCAN Foundation and The Commonwealth Fund—measures state-level performance of long-term services and supports systems that assist older people, adults with disabilities,

and their family caregivers.