Financial management services, often called FMS or a fiscal intermediary, are the back office of self-direction. The organization pays the worker, withholds taxes, tracks the person's budget, and often submits the Medicaid claim. States also say fiscal management agency or fiscal employer agent. The acronym in a family letter is usually FMS.
The FMS is not the provider agency. It does not typically train the worker, write the behavior plan, or decide who works Tuesday. The person or their representative is the employer, or shares that role. The fiscal agent makes the payment legal. Confusing the two is how a family calls payroll about a no-show, and how a worker calls payroll about a supervision problem nobody there is assigned to fix.
Enrollment is still Medicaid. The individual support plan authorizes the hours. The FMS is supposed to refuse payments that blow past the budget or that pay a relative the waiver does not allow. That gatekeeping is why people experience the fiscal agent as a bureaucracy even when they wanted self-direction in order to escape one.
Workers paid through an FMS may be called personal care attendants, support workers, or DSPs, depending on the service line. Their paycheck comes from the fiscal agent. Their schedule comes from the person who hired them. Benefits, overtime, and unemployment insurance follow the employer model the state picked, which is why two self-directed workers in two states can do the same Tuesday and have different pay stubs.
A rate cut aimed at "providers" does not always hit FMS administrative fees, and a cut aimed at self-directed wages does not always hit agency DSP scales. The budget line has to name which employer it means.