Tina Witowsky, age 20, suffered a brain trauma, similar to a massive stroke, four years ago. Following months of critical care, multiple surgeries, and intensive rehabilitation, Tina was able to come home, but she needs extensive in-home services and supports, which her private health insurance stopped covering. Without Medicaid, Tina’s mother would have had to move Tina into a nursing home, or leave her job to care for Tina full-time, sell her house, and find a job working nights. Instead, because Medicaid covers the care Tina needs, she can remain at home and in her community and school, and her mother can continue to work. Through a special Medicaid option in New Jersey, Tina and her mother “self-direct” Tina’s care, screening and hiring Tina’s caregivers themselves, within a fixed budget.