Consumer Directed Services Missouri: How CDS Works and How to Apply

Missouri's Consumer Directed Services program lets your parent hire their own caregiver — including adult children, siblings, or friends — and have Medicaid pay for it. It's one of three care models available through MO HealthNet, and it gives families the most control over who provides care and when.

The catch: your parent becomes the legal employer, and the program has strict rules about who qualifies, who can be hired, and what tasks are allowed.

Who Qualifies for CDS

To be eligible, your parent must meet all of these criteria:

• Missouri resident, age 18 or older
• Active MO HealthNet (Medicaid) beneficiary
• Nursing Facility Level of Care (scored at 18+ points on the InterRAI Home Care assessment)
• Physical disability requiring help with at least two activities of daily living
• Cognitive capacity to direct their own care, manage scheduling, and supervise their caregiver

That last requirement is the one most families miss. CDS is designed around self-determination — the participant is the boss. If your parent has moderate to advanced dementia and cannot direct their own care, CDS won't work. The Structured Family Caregiving Waiver is the alternative for those situations.

How to Apply

The application process runs through two state agencies simultaneously:

1. File for Medicaid through FSD — submit the IM-1SSL application and IM-1ABDS supplement to the Family Support Division. Countable assets must be below $6,220.50 for a single applicant.

2. Request a DSDS assessment — call the HCBS Central Referral Line at 1-866-835-3505 or submit an online referral. DSDS will schedule an in-home InterRAI assessment.

3. Select CDS as your care model — after the assessment confirms Nursing Facility Level of Care, the participant signs a Participant Choice Statement electing the CDS program.

4. Choose a fiscal agent — contact a state-approved Center for Independent Living (CIL). Two major fiscal agents are The Whole Person (Kansas City, 816-561-0304) and Services for Independent Living (Columbia).

Services typically begin within 30 to 45 days of intake.

Who Can Be a Personal Care Attendant

CDS allows hiring:

• Adult children
• Siblings and other relatives
• Friends and neighbors
• Professional caregivers

CDS does not allow hiring:

• The participant's spouse
• A court-appointed legal guardian

Every caregiver must pass background screenings through the Family Care Safety Registry (FCSR) and clear the Employee Disqualification List (EDL). The FCSR registration fee is approximately $15.

What a Personal Care Attendant Can and Cannot Do

Missouri regulates caregiver tasks under 13 CSR 70-91.010. The rules break down into three tiers:

Approved personal care tasks:

• Verbal medication reminders, bringing pre-poured medications
• Bathing, dressing, grooming, and mobility assistance
• Meal preparation, light housekeeping
• Applying OTC compression stockings (15-30 mmHg)

Advanced personal care tasks (with training):

• Opening medication packaging, steadying hands for application
• Setting up nebulizer equipment with pre-packaged medication
• Applying Class II therapeutic compression stockings (30-40 mmHg)
• Cleaning external catheter tubing, emptying drainage bags

Strictly prohibited (nursing only):

• Administering injections
• Suctioning tracheostomies
• Inserting or changing internal catheters
• Applying Class III prescription compression stockings

How the Fiscal Agent Works

The participant is the legal employer, but the fiscal agent handles the back-office work. They manage payroll, tax withholdings, IRS reporting, workers' compensation insurance, and payments to the Missouri Department of Revenue. The program is free to Medicaid-eligible participants — no cost comes out of pocket.

As the employer, the participant is responsible for recruiting, scheduling, and if necessary, dismissing their attendant. If a caregiver doesn't show up, the burden falls back on the family.

The Missouri Home Care Guide includes the full CDS enrollment workflow, a side-by-side comparison with the Agency Model and SFCW, and the complete task authorization chart.

See more Missouri guides →