Background Our aim was to explore previously unknown long‐term outcomes of self‐directed personal care services for young adults with intellectual disabilities and limitations in activities of daily living. Materials and Methods The present authors utilized participatory action research and qualitative content analysis in interviewing 11 unpaid familial programme representatives of young adults with intellectual disabilities, ages 23–34, who were eligible for income‐based Medicaid and enrolled five or more years in a Cash and Counseling‐based programme of self‐direction in the United States. Results Young adults are represented as receiving services and supports in a supportive and stable environment, with previously identified short‐term programme benefits evident over the long‐term. Young adults are also transitioning to adulthood at home with their families as primary social support and caregivers, bridging a service gap. Conclusions Our results show that self‐direction helps meet these young adults’ personal care and community engagement needs over time.