When you are told two different things

Sooner or later, everyone in this program is told two different things about the same question. Your service coordinator says one thing. A parent in a Facebook group says another. Your independent facilitator remembers it differently. Your FMS says the thing you were promised cannot be paid.

This is the single most common source of conflict in Self-Determination, and it is rarely because anyone is lying to you. It is worth understanding why, because the reason tells you what to do next.

Why it happens so much

Twenty-one regional centers read the same rules. DDS issues directives and guidelines to all of them. Each center then writes its own procedures for following them. Two centers can arrive at genuinely different practices from identical text, and both can be acting in good faith.

Inside one center, staff vary. Service coordinators carry large caseloads and the program is still young. Someone who has run forty self-determination plans knows things someone running their third does not.

Much of the program is deliberately individual. Self-Determination exists to let your plan be different from someone else's. So when another family tells you what they get, they are usually describing their plan — accurately — and it tells you almost nothing about what belongs in yours.

The rules move. Directives supersede earlier directives. Minimum wage changes. Waiver terms are renewed. Something that was true in 2023 can be wrong now, and the person telling you learned it when it was true.

And some questions genuinely have no settled answer yet. Where that is the case, the honest response is to say so, which is not what anyone wants to hear.

The four kinds of disagreement

Almost every conflict is one of these four, and they have completely different remedies. Working out which one you have is most of the job.

One: somebody is simply mistaken

There is a clear rule, written down, and one of you has it wrong. It might be you. It might be the person who told you.

What to do: find the document. Ask "which directive or regulation says that?" A rule that really exists can be pointed at. This is the easiest kind to settle and the least common of the four.

Two: it is genuinely up to your planning team

There is no rule to find, because the answer is meant to be decided for you individually. How much of a service you need, whether a particular support meets your goals, what your budget covers — much of this is the planning team's to determine.

This is the kind people most often mistake for the first kind. When someone says "you can get X," they may be telling you truthfully that their team agreed to X. That is not a rule, and repeating it to your own team as though it were one tends to go badly.

What to do: stop looking for the document, because there isn't one. Make the case to your planning team, and get the decision written down.

Three: the rule is clear, and people apply it differently

The most frustrating kind. Nobody is wrong about what the rule says; they differ on what it requires in practice. Different centers, different coordinators, different providers, each with their own reading and their own tolerance for risk.

What to do: get the interpretation in writing from whoever will have to act on it. A verbal yes from someone who is not the one paying, approving or authorising is not worth much — not because they are untrustworthy, but because they are not the one who will be asked to stand behind it.

Four: the rule allows it, but this provider does not do it

The kind nobody warns you about. Nothing is being misread and nobody is overruling anyone. The rule permits the thing, and your provider has made a business decision not to do it — or cannot do it with the systems they have.

That sounds like an excuse until you look at what an FMS is actually carrying. It hires staff on your behalf and becomes an employer of record. It pays caregivers and vendors, in many cases before the money for it has arrived. If a payment later turns out not to have been properly authorised, the provider can be the one left holding it. Not the family, and not the regional center.

We publish this site and we are one of those providers, so read that as an interested party explaining itself. We go into it further below.

So providers land in different places on questions like how much documentation they want before releasing a payment, how quickly they will pay something unusual, what they will approve without written authorisation first, and which things their software can even handle. Two providers can both be right and still give you opposite answers, because they are pricing the same risk differently.

What to do: ask why, and listen to the shape of the answer rather than just the yes or no. This is the single most useful question in the whole vetting process.

A provider who has been doing this a while will have a real reason — a claim they once ate, an audit finding, a rule they got caught by — and will tell you what it was. That answer is worth more than a yes, because it tells you they have thought about it and will behave predictably when your situation gets complicated. A provider who cannot explain a practice beyond "that is our policy" has either not thought it through or would rather not say, and both are things you want to find out now rather than in month four.

Vet this upfront, not after something goes wrong. Ask what they will not do, and why. An established provider will have solid answers to nearly everything you put to them. There is a list of questions worth asking on choosing an FMS, and it is far easier to ask them before you sign up than to discover the answers one at a time afterwards.

What outranks what

When two sources genuinely conflict, this is the order of authority:

1. Federal Medicaid waiver terms. Self-Determination operates under a waiver. Nothing below can authorise what the waiver forbids.
2. State law — the Lanterman Act and the Welfare and Institutions Code.
3. Regulations — Title 17 of the California Code of Regulations.
4. DDS directives and program guidelines, which bind regional centers.
5. Regional center policy and procedure.
6. What somebody told you.

In practice, most disputes never reach the top of that ladder. They live between four, five and six — a directive that a center reads one way, a coordinator who learned it another way. That is worth knowing, because families sometimes go looking for a statute to settle something that statute does not address.

The document that governs you is your own plan

This is the part most worth carrying away.

Your IPP and your spending plan are the operative documents for you. Not the general rule, and certainly not somebody else's plan.

Two consequences follow, and both cause arguments:

• A rule that permits something does not put it in your budget. The program may allow a service in principle while your plan does not include it. "It is allowed" and "it is funded for me" are different sentences.
• Someone else's plan authorises nothing in yours. Their approval was a decision about their circumstances by their team.

So when you hear something that sounds like good news, the useful question is not "is that allowed?" It is "is that in my plan, and if not, what would it take to put it there?" Spending plans can be changed.

Why your FMS sometimes says no when someone else said yes

We should be straight about our own part in this, because it is a common flashpoint and we are one of the parties involved.

An FMS does not decide what you may have. We are not in your planning meeting, we do not write your spending plan, and we should have no influence over either — if we did, that would narrow your choice rather than widen it. What we are responsible for is making sure money is spent in line with the plan that was approved, DDS guidance and the waiver.

So when an FMS says something cannot be paid, that is almost never a second opinion overruling your regional center. It is usually a mismatch: what is being asked for does not match what the approved plan authorises. The plan may say a different service code, a different amount, or nothing at all about it.

Which means the fix is usually not to argue with the FMS. It is to get the plan amended so it covers the thing you want, and then the payment follows. Your FMS should be able to tell you exactly what the mismatch is, in writing, so you can take something specific to your team rather than "they said no."

The other reason, which is about risk rather than rules

Sometimes nothing is mismatched and the answer is still no, or not yet, or not without paperwork first. That is the fourth kind of disagreement above, and it deserves saying plainly from our side of it.

An FMS is not a bank that passes money through. It becomes an employer of record for your staff, and it releases payments to caregivers and vendors — often before the money covering them has landed. When a payment turns out not to have been properly authorised, the provider is frequently the one who absorbs it. Nobody sends the family an invoice for it.

That is why a provider asks for a timesheet, a signature, or an authorisation before releasing money, and it is why two providers answer the same question differently. They are not applying different rules. They are carrying different amounts of risk and have decided differently about how much to carry. Some will move faster on an unusual request and absorb more exposure; others want it documented first. Software matters too: a thing one provider's system handles routinely may be something another genuinely cannot process.

None of that makes a provider right. It makes the reason worth asking for. A provider who can tell you why they work the way they do is showing you how they will behave when your situation gets complicated — which is the thing you actually need to know, and which no published figure anywhere will tell you.

And if your FMS has simply got it wrong — which happens — ask them which rule they are relying on. A provider who cannot name one should think again.

What to do, in order

1. Write down what you were told, by whom, and when. Most of these disputes become unresolvable because nobody can reconstruct who said what.
2. Ask which document it comes from. Politely and every time. It is a fair question and it sorts kind one from kind two almost immediately.
3. Ask for the answer in writing from the person who will have to act on it.
4. Take it to your planning team if it is a kind-two question. That is the forum that exists for deciding it.
5. Get the outcome into the IPP or the spending plan. A decision that is not written into a document does not survive a change of coordinator.
6. If the answer is a formal no, treat it as one — see below.

Where this comes up most

These are the questions that generate the most conflicting advice, each of which has its own entry:

• Paying a relative. Turns on the legally responsible person rules, and the answer changes with the person's age and the relationship.
• Background checks, where whether someone lives in the same home matters.
• What counts as a participant-directed good or service — see the entry, which is narrower than most people expect.
• What you may pay staff, and what a raise does to the hours your budget buys.
• Overtime, where the rules differ for live-in staff and personal attendants.
• Respite, and what limits actually apply.

When it becomes a formal no

There is an important line here that costs families real money when they cross it wrongly.

If a service is denied, reduced or ended, that decision should come with a written notice, and that notice starts an appeal clock. An appeal is the route that challenges the decision itself, and it is the one with deadlines attached.

A grievance is a different thing: it is a complaint about how you were treated or how a process was run. Filing a grievance does not challenge the decision and does not pause the appeal clock. Choosing the wrong one, or waiting while the wrong one runs, is one of the few mistakes in this program that cannot be undone later.

The Ombudsperson can also help when something is going wrong and you are not sure what kind of problem you have.

Check the deadline on your own notice rather than on anything written here or told to you in a meeting. The date on your paperwork is the one that governs.

And if nothing came in writing at all, that is itself the thing to fix. A decision delivered in a meeting still carries appeal rights; a Notice of Action is how they reach you. Ask for one. If you are sent a letter saying the regional center understood you had agreed, saying plainly that you did not agree obliges them to issue the notice.

Still to come

• A worked example, following one ordinary disagreement from "someone told me" through to a written outcome.