Consumer Directed Services in Missouri: Everything You Need to Know (2026)

Most people with disabilities in Missouri do not want to move to a nursing facility. They want to stay home, keep their routines, and receive care from someone they trust. Consumer Directed Services (CDS) makes that possible through Missouri Medicaid, and Family United Health Care helps Missouri residents enroll in this program every day.

This guide covers everything: what consumer directed services are, the real benefits the program delivers, MO HealthNet requirements, exactly who qualifies and who does not, what is covered, what to look for in a personal care assistant, how to pay a family member as your caregiver, how payments work, and how to apply step by step.

Consumer directed services are available across all of Missouri, including St. Louis, Kansas City, Springfield, Columbia, Jefferson City, Independence and more…

What Are Consumer Directed Services?

Consumer Directed Services (CDS) is a Missouri Medicaid program that pays a caregiver of your choosing, including a family member, to provide personal care in your home. You control who provides your care, what tasks they perform, and when they come. You act as the employer; Missouri Medicaid covers the cost.

Consumer Directed Services (CDS) is a Missouri Medicaid program that gives individuals with disabilities full control over their own personal care. Instead of a home care agency choosing who shows up at your door, you choose your own caregiver, decide what tasks they help with, set the schedule, and supervise the work yourself.

The term “consumer directed” means the person receiving care is the one directing it. In health care, “consumer” refers to the patient or the care recipient. When services are “consumer directed,” power shifts away from agencies and institutions and into the hands of the individual who actually needs the help.

The Centers for Medicare and Medicaid Services (CMS) has documented that participants in self-directed care programs report higher satisfaction, better health outcomes, and fewer hospitalizations compared to those in agency-managed care.

In Missouri, the CDS program is funded through MO HealthNet, the state’s Medicaid program. That means it is available at little to no personal cost for people who meet the eligibility requirements.

Why Consumer Directed Services Matter in Missouri

According to the U.S. Census Bureau’s American Community Survey, approximately 29 percent of Missouri adults live with some form of disability. Many of those individuals need daily personal care support but want to remain in their homes and communities.

According to the Genworth Cost of Care Survey, the average annual cost of a nursing home in Missouri exceeds $55,000 per year. Private home care through an agency typically runs $25 to $35 per hour. CDS funded by MO HealthNet allows a qualified participant to receive personal care at home at little to no personal cost, with a caregiver of their choosing.

Without a program like CDS, someone who needs nursing-facility-level care faces three options:

1. Pay for private home care at $25 to $35 per hour out of pocket
2. Rely entirely on unpaid family members with no compensation
3. Enter a nursing facility at a cost exceeding $55,000 per year

CDS creates a fourth option: Medicaid pays a trusted caregiver of your choosing to support you at home. That caregiver can even be a family member.

What Missouri Families Tell Us About CDS

Based on Family United Health Care’s enrollment experience across Missouri, the most common questions we receive are about paying family members as caregivers, the MO HealthNet income limits, and how long the approval process takes. Below is what our data shows.

At Family United Health Care, we have guided +600 Missouri families through the consumer directed services enrollment process. Here is what our experience consistently shows:

• 90% of our CDS participants hire a family member as their personal care assistant, most commonly an adult child or sibling
• The most common reason families contact us is learning for the first time that Missouri Medicaid will pay a family member they already trust
• The most common disqualifying factor we see is household income slightly above MO HealthNet limits, which is often solvable through Medicaid spend-down that applicants were not aware of
• 75% of applicants who initially believe they do not qualify are eventually enrolled with the right guidance

Benefits of Consumer Directed Services in Missouri

The core benefits of consumer directed services in Missouri are: you choose your caregiver including family members, you set the schedule, you stay in your own home, and Missouri Medicaid covers the cost. For families, it converts unpaid caregiving into paid employment without disrupting the existing care arrangement.

• You Choose Who Cares for You

Instead of accepting whoever an agency sends, you recruit and hire the person you want. That person can be a family member, a trusted friend, or a community member who genuinely understands your needs. The quality of daily care improves dramatically when both parties already have a trusting relationship.

• Your Caregiver Gets Paid for Care They Are Already Providing

For thousands of Missouri families, an adult child, sibling, or parent is already providing unpaid care. CDS turns that unpaid labor into legitimate paid employment. The family caregiver receives a real paycheck, W-2 documentation, and workers’ compensation coverage, all processed through the Fiscal Employer Agent.

• You Set the Schedule Around Your Life

With traditional agency care, you work around the agency’s availability. With CDS, you and your caregiver set the schedule together based on your actual life, your routines, your medical appointments, and your personal preferences.

• You Stay in Your Home and Community

CDS is specifically designed to keep people out of nursing facilities. You remain in the home you know, surrounded by your neighborhood, community, and the people who matter to you. Research consistently links community-based living to better mental health, higher life satisfaction, and improved physical health outcomes for people with disabilities.

• Greater Personal Control and Dignity

You decide the order things get done, which products your caregiver uses, how your space is maintained, and how your daily routine flows. These details define quality of life.

• Better Health Outcomes

Research supported by the Robert Wood Johnson Foundation has found that self-directed care participants experience fewer emergency room visits, fewer preventable hospitalizations, and better overall self-reported health than comparable participants in traditional care settings.

• Relief From Financial Pressure on Family Caregivers

When family members are compensated for their caregiving work, they experience less financial stress and feel more supported in a role that is physically and emotionally demanding. Reduced financial pressure directly lowers the burnout risk that affects unpaid family caregivers across Missouri.

How CDS Works in Missouri

In Missouri’s CDS model, you act as the employer of your own personal care assistant. You hire and supervise them. A Fiscal Employer Agent (FEA) handles payroll and taxes on your behalf. A support broker helps you manage the administrative responsibilities.

Consumer directed services in Missouri operate on a self-direction model. You recruit, interview, hire, train, and supervise your own caregiver without going through a staffing agency.

• Traditional home care: An agency selects the caregiver, controls the schedule, sets the tasks, and supervises the worker. You have little input.
• Consumer directed services: You control every decision. You choose who cares for you, when they come, what they do, and how they do it. The program gives you the funding and the infrastructure to act as an employer without managing payroll yourself.

The self-direction model follows a structure authorized under Section 1915(c) of the Social Security Act, which allows states to offer Medicaid-funded home and community-based services as an alternative to institutional care.

The Three Key Players in Missouri’s CDS Program

Three parties make CDS function in Missouri: (1) the participant, who acts as the employer and directs their own care; (2) the support broker, a trained advisor who helps with administrative responsibilities; and (3) the Fiscal Employer Agent (FEA), which handles payroll, taxes, and background checks.

1. The Participant (You)

The participant is the person with a disability who receives services and acts as the employer. Your responsibilities include:

• Recruiting and interviewing potential caregivers
• Hiring the caregiver who best fits your needs
• Training your caregiver on your specific care routine
• Setting the work schedule within your approved hours
• Supervising daily tasks and evaluating performance
• Approving timesheets before they go to payroll
• Making staffing changes when needed

If a participant cannot handle employer responsibilities independently due to their disability, a representative such as a trusted family member can act on their behalf.

2. The Support Broker

A support broker is a trained professional who helps you manage the administrative side of being an employer. They do not choose your caregivers or supervise your care. Support broker responsibilities include:

• Developing a written plan of care with you
• Explaining your rights and responsibilities
• Assisting with caregiver recruiting and paperwork
• Helping resolve conflicts
• Connecting you with community resources
• Keeping you within your approved budget

This service is part of the CDS program at no additional cost to you.

3. The Fiscal Employer Agent (FEA)

The FEA handles all employer-related financial functions on your behalf. The FEA manages:

• Processing timesheets
• Issuing paychecks or direct deposits
• Withholding and remitting federal and state payroll taxes
• Managing workers’ compensation coverage
• Running background checks on your caregivers

Missouri Medicaid Programs That Include CDS

Consumer directed services are available through multiple MO HealthNet programs. The core program is the CDS State Plan, which serves adults 18 and older with physical disabilities. Additional waivers serve adults with brain injuries, technology needs, and children with complex medical conditions. Family United Health Care supports enrollment across all programs listed below.

Not sure which program applies to your situation? Contact Family United Health Care and we will identify the right program and guide you through enrollment at no cost.

MO HealthNet Requirements for Consumer Directed Services

To access consumer directed services, you must qualify for MO HealthNet (Missouri Medicaid). Requirements include income under $885/month for a single individual, countable assets under $2,000 for a single individual, Missouri residency, and U.S. citizenship or qualified immigrant status. If your income is over the limit, spend-down may still allow you to qualify.

MO HealthNet is Missouri’s Medicaid program, administered by the Missouri Department of Social Services (DSS). Qualifying for MO HealthNet is the financial gateway to consumer directed services.

• Income Requirements

Income that counts: wages, Social Security benefits (SSI, SSDI, retirement), pensions, veterans benefits in most cases, rental and investment income.

Income that does not count: the first $20 of most monthly income, the first $65 of earned income plus half of earnings above that, certain irregular income.

• Asset Requirements

Exempt assets (do not count):

• Primary home up to approximately $585,000 in equity
• One motor vehicle regardless of value
• Personal belongings and household goods
• Prepaid burial plans within certain limits
• Term life insurance with no cash value
• Whole life insurance with a face value of $1,500 or less

Countable assets: checking and savings accounts, CDs, stocks, bonds, mutual funds, second vehicles or properties, cash value of whole life policies above the exemption.

• The Medicaid Spend-Down Option

If your income exceeds MO HealthNet limits, you may still qualify through Medicaid spend-down. Missouri calculates the difference between your income and the income limit. If you have documented medical expenses (bills, prescriptions, insurance premiums) that bring your net income to the eligible level, you qualify for that period. Spend-down is calculated in six-month periods.

• Residency and Citizenship

To qualify you must be a current Missouri resident and a U.S. citizen, a qualified immigrant, or meet specific immigration status requirements. Qualified immigrants may be subject to a five-year waiting period for federal Medicaid.

• Managed Care in Missouri

Most MO HealthNet members who qualify for CDS are enrolled in a Medicaid Managed Care Organization (MCO). As of 2026, Missouri’s managed care plans include Healthy Blue Missouri, Show-Me Health, and UnitedHealthcare Community Plan Missouri, among others. Your MCO assigns your case manager and supports your CDS enrollment.

Documents Needed to Apply

• Photo ID (driver’s license, state ID, or passport)
• Proof of Missouri residency (utility bill, lease, or bank statement)
• Social Security numbers for all household members applying
• Proof of income (pay stubs, Social Security award letters, pension statements)
• Bank account statements for the past three months
• Proof of assets (property deeds, vehicle titles, investment statements)
• Current health insurance cards
• Medical bills or insurance premiums paid regularly (for spend-down applicants)

How to Apply for MO HealthNet

• Online: MyDSS.mo.gov
• In person: At your local Family Support Division office
• By mail: Printed application at dss.mo.gov

Processing typically takes 30 to 45 days.

Who Qualifies for CDS in Missouri

To qualify for consumer directed services in Missouri, you must be a Missouri resident aged 18 or older, enrolled in MO HealthNet (Medicaid), have a physical disability that prevents independent performance of daily living activities, require nursing-facility-level care, and be cognitively able to direct your own care or have an authorized representative who can.

You must meet all four categories: residency, age, medical need, and financial eligibility.

Medical Eligibility

• A physical disability preventing independent performance of activities of daily living
• Level of care equal to or exceeding nursing facility admission requirements
• Cognitive ability to direct your own care, or an authorized representative who can
• Care needs that can be safely met at home without around-the-clock skilled nursing

Activities of daily living (ADLs) evaluated:

Functional Assessment

A care coordinator or DSDS caseworker visits your home and conducts a functional assessment to measure how much help you need with each task. This calculates your approved weekly hours of CDS service.

Who Does NOT Qualify for CDS

You do not qualify for Missouri’s CDS program if you are under 18, lack Medicaid coverage and cannot financially qualify, have only an intellectual or developmental disability, require 24-hour skilled nursing care, have no one to act as employer-participant, live in a nursing facility, or live outside of Missouri.

• Under age 18. The adult CDS state plan is for adults only.
• No MO HealthNet coverage and cannot qualify financially. Medicare alone does not cover CDS. Private insurance does not fund it.
• Only diagnosis is intellectual or developmental disability (IDD). CDS targets physical disabilities. People with IDD have separate Missouri waiver programs.
• Care needs require 24-hour skilled nursing. CDS covers personal care tasks, not clinical nursing care.
• Cannot direct care and have no authorized representative. The employer-participant role must be filled for the program to function.
• Living in a nursing facility or institution. CDS is community-based. Nursing facility, assisted living, and group home residents are not eligible while in those settings.
• Living outside of Missouri. Medicaid programs are state-specific.
• Income and assets exceed Medicaid limits with no spend-down path. Financial MO HealthNet eligibility is required.
• Spouse wants to be the paid caregiver. Missouri prohibits spouses and legal guardians from being hired as paid CDS caregivers.
• Caregiver candidate fails a background check. Convictions related to abuse, neglect, or financial exploitation are disqualifying.

If you do not qualify today, changes in health, income, assets, or living situation can affect eligibility over time. Family United Health Care can help you identify your options. 

Services CDS Covers and What It Does Not

CDS covers personal hygiene, dressing, grooming, mobility assistance, medication reminders, meal preparation, light housekeeping, laundry, grocery shopping, and transportation to medical appointments. It does not cover skilled nursing, wound care, therapy services, or any task requiring a professional license.

Participants considering a provider change can learn how to switch CDS providers in Missouri without unnecessarily disrupting care.

Services That CDS Covers

Services That CDS Does NOT Cover

The key rule: If a task requires a professional license, CDS does not cover it.

Can You Pay a Family Member to Be Your Caregiver in Missouri?

Yes. Missouri’s CDS program allows Medicaid to pay adult children, siblings, parents, and other adult relatives to serve as your personal care assistant. The two exceptions are your spouse and your legal guardian, who cannot be hired as paid caregivers under the program.

Want to know if you can personally get paid to care for your mother or father? Read our detailed guide on Can I Get Paid to Care for My Parent in Missouri?

Under Missouri’s CDS program, you can hire and pay:

• Adult children
• Siblings
• Parents (if the participant is an adult)
• Adult relatives including aunts, uncles, cousins, and in-laws
• Trusted friends and neighbors

The two exceptions:

1. Your spouse cannot be your paid CDS caregiver under any circumstances
2. Your legal guardian cannot be your paid CDS caregiver

Many Missouri families use CDS specifically to formalize and compensate a caregiving arrangement that was already happening without pay. The family caregiver receives a W-2 at the end of the year, has payroll taxes withheld, and is covered by workers’ compensation through the FEA. The only change from their perspective is that they now get paid.

Every family’s situation is a little different, and the rules that matter most usually depend on who is doing the caring. A daughter caring for her mother faces a different set of questions than a husband caring for his wife, and the answers are not the same.

If you are trying to work out whether you personally can be paid, we wrote a detailed walkthrough covering who qualifies, what the pay actually looks like, and the mistakes that cost families money: Can I Get Paid to Care for My Parent in Missouri?

What to Look for in a Personal Care Assistant (PCA)

The most important qualities in a personal care assistant are reliability, willingness to follow your direction rather than substitute their own judgment, physical capability for required tasks, trustworthiness, emotional steadiness, good communication, personal compatibility, and genuine respect for your independence.

What a Personal Care Assistant Does

A Missouri CDS PCA provides non-medical personal care and support:

• Bathing, grooming, and personal hygiene
• Dressing and mobility assistance
• Meal preparation and eating assistance
• Light housekeeping related to daily living
• Grocery shopping and errands
• Transportation to medical appointments and community activities
• Medication reminders at scheduled times

A PCA does not perform skilled nursing tasks and does not make clinical decisions. They follow your direction at all times.

Eight Qualities to Prioritize

1. Reliability above everything else. In personal care, unreliability is a safety risk, not just an inconvenience. Check attendance history through references before hiring.

2. Willingness to take your direction. CDS works only when the PCA understands that you are in charge. Look for someone who listens carefully and follows your instructions.

3. Physical capability. Confirm a candidate can safely perform required tasks such as transfers or repositioning.

4. Trustworthiness and integrity. Background checks catch serious issues, but references and interviews reveal character.

5. Emotional steadiness. A PCA who responds calmly to unexpected situations and manages difficult days without bringing external stress into your home is invaluable.

6. Good communication. You need a PCA who tells you clearly when something is wrong, when they cannot make a shift, or when they notice a change in your condition.

7. Cultural and personal compatibility. Shared communication styles, language, and cultural understanding all contribute to a successful long-term relationship.

8. Respect for your independence. The best PCAs support what you can do yourself rather than taking over. They encourage autonomy rather than creating dependency.

Interview Questions to Ask a PCA Candidate

• Tell me about your previous experience providing personal care.
• What would you do if you arrived for a shift and I had fallen or was unresponsive?
• How do you handle a situation where your opinion differs from what I actually want?
• Describe a time you had a conflict with someone you worked with. How did you handle it?
• Are you comfortable with the specific tasks this position requires?
• What is your availability on evenings and weekends?
• Do you have reliable transportation to arrive on time?
• Can you provide references from previous employers or care recipients?
• Do you have any prior legal history that would appear on a background check?

Red Flags to Watch for

• Reluctance to provide references or explain employment gaps
• Speaking negatively about previous care recipients
• Arriving late or unprepared for the interview itself
• Evasive answers about prior legal history
• Insisting they know better than you what your care should look like

Background Check Requirement

Every PCA must pass a background check run by the FEA before beginning paid work. The check screens for convictions related to abuse, neglect, financial exploitation, sexual offenses, and drug-related offenses in care settings. No paid hours can occur before the check clears.

How to Choose and Hire Your Own Caregiver

To hire a CDS caregiver in Missouri, identify a candidate, interview them, submit hiring paperwork to your support broker and FEA, wait for the background check to clear, then begin services. No paid hours can occur before the background check clears.

All caregivers must be 18 or older, pass a background check, be authorized to work in the United States, and not be your spouse or legal guardian.

Step 1: Write a job description with your support broker covering tasks, hours, and personal preferences.

Step 2: Recruit candidates through your personal network, community platforms, or Family United Health Care.

Step 3: Interview candidates. You make the final decision.

Step 4: Submit hiring paperwork to the FEA: employment verification, direct deposit setup, tax forms, and background check consent.

Step 5: Wait for the background check to clear, typically a few days to one week.

Step 6: Services begin once your caregiver is fully enrolled and cleared.

How CDS Caregivers Get Paid in Missouri

CDS caregivers in Missouri are paid as W-2 employees through the Fiscal Employer Agent (FEA). You approve your caregiver’s timesheet each pay period. The FEA issues payment via direct deposit or check and handles all payroll taxes and workers’ compensation. You never pay your caregiver directly.

The Pay Process

1. Your caregiver tracks hours through Missouri’s required Electronic Visit Verification (EVV) system via smartphone app or phone check-in.
2. At the end of each pay period, you review and digitally approve the timesheet.
3. The FEA processes the timesheet and issues payment, typically within a few business days.
4. The FEA handles all tax withholdings, workers’ compensation filings, and employer-side submissions.

Caregiver Pay Rates in Missouri

As of 2026, personal care assistants in Missouri’s CDS program typically earn between $11 and $15 per hour, depending on the specific program, county, and applicable minimum wage requirements.

Missouri Medicaid reimbursement rates are updated periodically. Verify the current rate with the Missouri Division of Senior and Disability Services at 573-526-3626 or contact Family United Health Care before making decisions based on this figure.

Caregivers should also understand Electronic Visit Verification (EVV) for Missouri caregivers, since accurate visit records are tied to timekeeping and payroll.

For more details about hourly wages, taxes, approved hours, and estimated monthly earnings, read How Much Does Missouri Medicaid Pay Family Caregivers?

Taxes and Workers’ Compensation

Your caregiver receives a W-2 at the end of each year. They are a W-2 employee, not an independent contractor. The FEA handles all employer-side tax obligations. If your caregiver is injured while providing care, the FEA’s workers’ compensation policy covers that claim.

How to Apply for Consumer Directed Services in Missouri

Apply for MO HealthNet (Medicaid) at MyDSS.mo.gov first. Once approved, request a functional assessment through DSDS or your managed care organization. Then work with a case manager to develop your care plan, connect with a support broker, complete CDS enrollment, hire your personal care assistant, and begin services. The full process typically takes four to twelve weeks.

Step 1: Apply for MO HealthNet (Medicaid)

• Online: MyDSS.mo.gov
• By phone: 855-373-4636
• By mail: Printed application at dss.mo.gov

Processing takes 30 to 45 days.

Step 2: Request a Functional Assessment

Contact Missouri DSDS at 573-526-3626 or your managed care organization. A caseworker visits your home, evaluates your ability to perform daily living activities, and calculates your approved weekly CDS hours.

Step 3: Develop Your Person-Centered Plan

A case manager works with you to create a Person-Centered Plan (PCP) describing your care goals, the services you will receive, and how you want your daily life to look. It is created with you, not for you.

Step 4: Connect With a Support Broker

Your case manager connects you with a support broker who guides you through CDS enrollment and remains as an ongoing resource throughout the program.

Step 5: Complete CDS Enrollment

Your support broker helps you sign the participant agreement, select your FEA, set up your EVV account, and complete required training on your role as an employer-participant.

Step 6: Hire Your Personal Care Assistant

Recruit, interview, and select your PCA. Submit hiring paperwork and wait for the background check to clear.

Step 7: Begin Services

Once your PCA’s background check clears and all paperwork is complete, services begin. Your PCA logs hours via EVV and you approve timesheets each pay period.

CDS vs. Traditional Agency Home Care

Consumer directed services give you full control over who provides your care, including family members, at little to no cost through Medicaid. Traditional agency home care is fully managed by an agency. At Family United Health Care, we offer both programs so you can choose the model that fits your life.

At Family United Health Care, we offer both programs, consumer directed services and traditional agency home care in Missouri, because different families have different needs and neither model is universally right for everyone.

Choose consumer directed services if you have a trusted family member or friend available, want full control, or want your family member compensated for care they already provide.

Choose traditional agency home care if you have no available personal network, prefer no employer responsibilities, or need care to start immediately.

Contact Family United Health Care to discuss both options before applying to either.

Common Consumer Directed Services Mistakes in Missouri

The most costly mistakes Missouri CDS participants make are allowing a caregiver to start working before FEA enrollment is complete (those hours are not reimbursable), and approving timesheets without reviewing them carefully (which creates liability for the participant as the employer).

• Mistake 1: Assuming a family caregiver is automatically approved. Every caregiver, including family members, must pass a background check and complete FEA enrollment before working any paid hours.
• Mistake 2: Letting your PCA work before official enrollment. Hours worked before enrollment are not reimbursable by Medicaid. This is the most common and costly mistake new participants make.
• Mistake 3: Approving timesheets without reviewing them. You are the employer. Approving inaccurate hours creates liability that falls on you.
• Mistake 4: Not using your full approved hours. Approved hours reflect your assessed needs. Not using them means you receive less care than you qualify for.
• Mistake 5: Skipping caregiver training. Even experienced caregivers need to learn your specific routines and preferences from day one.
• Mistake 6: Not reporting income or asset changes to Medicaid. Unreported changes can result in overpayments you must repay, or sudden loss of eligibility.
• Mistake 7: Waiting too long to address a PCA who is not working out. Delays create care gaps and compounding problems. Act quickly.
• Mistake 8: Not identifying a backup PCA before you need one. Illness and emergencies happen. Have a backup identified from the beginning.

Missouri Resources and Contact Information

Conclusion

Consumer directed services in Missouri give people with disabilities something most care programs never offer: real control. You choose who cares for you. You set the schedule. You direct the work. You stay in your own home, in your community, near the people and places that matter to you.

The benefits are concrete. CDS allows family members to be compensated for care they are already providing. It keeps you out of a nursing facility that costs over $55,000 per year. It creates continuity through a caregiver who truly knows you. And it produces measurably better health outcomes than institutional alternatives.

At Family United Health Care, we offer both consumer directed services and traditional agency home care across all of Missouri. Whether you want full control through CDS or a fully managed arrangement through agency care, our team guides you to the right fit and handles the enrollment process from start to finish, across St. Louis, Kansas City, Springfield, Columbia, Jefferson City, and every county in the state.

Contact Family United Health Care today at (314) 716-3100 and take the first step toward staying home, staying independent, and staying in control.

Frequently Asked Questions About Consumer Directed Services in Missouri

What is consumer directed services (CDS)?

Consumer directed services is a Missouri Medicaid program that allows individuals with physical disabilities to hire, train, and supervise their own personal care assistant instead of having a home care agency assign one. The participant controls who provides their care, what tasks are performed, and when.

What is the difference between consumer directed services and self-directed services?

The terms are interchangeable. In Missouri the official name is Consumer Directed Services (CDS). At the federal level it is also called participant-directed services or self-directed care. All describe the same model: the person receiving care acts as the employer of their own caregiver.

What is a personal care assistant (PCA)?

A PCA provides hands-on daily care under the CDS model, including bathing, dressing, grooming, meal preparation, mobility assistance, housekeeping, grocery shopping, transportation, and medication reminders. They are not licensed medical professionals and do not perform skilled nursing tasks.

What is the difference between a personal care assistant and a home health aide?

A PCA provides non-medical personal care under your direct supervision. A home health aide (HHA) is trained and often certified to perform basic health-related tasks such as vital sign monitoring. HHAs typically work under clinical supervision through agencies. PCAs in CDS are directed entirely by you.

Can I hire my adult child as my CDS caregiver in Missouri?

Yes. An adult child must pass a background check, complete FEA enrollment, and receive wages as a W-2 employee. The only family members who cannot be hired are spouses and legal guardians.

Can I pay a family member to be my caregiver through Missouri Medicaid?

Yes. Missouri’s CDS program allows Medicaid to pay adult children, siblings, parents, or other adult relatives. Spouses and legal guardians are the only excluded family members.

What are the income limits for MO HealthNet to qualify for CDS?

A single individual must have monthly income below approximately $885. A married couple must have income below approximately $1,198 per month. A Medicaid spend-down may still allow you to qualify if your income exceeds these limits.

What assets can I keep and still qualify for Medicaid in Missouri?

A single individual can have up to $2,000 in countable assets. A married couple up to $4,000. Exempt assets include your primary home up to $585,000 equity, one vehicle, personal belongings, and certain burial and life insurance arrangements.

How much do CDS caregivers get paid in Missouri?

Personal care assistants typically earn between $11 and $15 per hour as of 2026. Rates vary by program and region and are updated periodically by MO HealthNet.

How many hours of care can I get through CDS?

Approved hours are determined by a functional assessment and vary by individual need. There is no universal cap.

How long does CDS approval take in Missouri?

Typically four to twelve weeks from Medicaid application to first day of services.

Does Medicare cover consumer directed services?

No. CDS is a Medicaid program. If you have both Medicare and Medicaid, you may qualify for CDS through your Medicaid coverage.

Can I lose CDS benefits if I start working or go to school?

Not automatically, but earned income counts toward MO HealthNet eligibility. Speak with a caseworker before making significant income changes.

What happens if my PCA is sick or unavailable?

Managing availability is your responsibility as the employer. Identify a backup PCA before you need one. Your support broker can help you plan for this.

Can I fire my personal care assistant?

Yes. You are the employer and have full authority to end the employment relationship for any lawful reason.

Can I have more than one PCA?

Yes. Many participants have two or more PCAs covering different shifts or days for built-in backup coverage.
Families who need more scheduling flexibility can learn more about having multiple caregivers through Missouri CDS.

What happens during a functional assessment for CDS?

A caseworker visits your home and evaluates your ability to independently perform each activity of daily living, then calculates your approved weekly CDS hours.

What is a Person-Centered Plan?

A written document developed with your case manager that describes your care goals, daily routines, preferences, and services. It reflects your actual life and guides your PCA’s work.

What is Medicaid spend-down in Missouri?

A provision allowing people whose income exceeds MO HealthNet limits to still qualify by deducting documented medical expenses from their income.

What is Electronic Visit Verification (EVV)?

A federal requirement under the 21st Century Cures Act. In Missouri, PCAs clock in and out for each shift via smartphone app or telephone, creating a documented record that services occurred.

What is the difference between CDS and traditional home care?

CDS gives you full control including the ability to hire family members. Traditional agency home care is fully managed by an agency that selects and supervises your caregiver.

Does Family United Health Care offer both CDS and traditional home care?

Yes. Family United Health Care offers both programs in Missouri and helps you choose the right fit for your situation.

Is CDS available in rural Missouri?

Yes, statewide across all 114 counties. Hiring family and friends makes access in rural areas significantly easier than agency-based models.

What is the CDS participant agreement?

A document signed during enrollment outlining your rights and responsibilities as an employer-participant.

What is a fiscal employer agent (FEA)?

An organization approved by MO HealthNet that handles payroll, taxes, workers’ compensation, and background checks so the participant does not have to manage those functions directly.