Missouri DSDS Services: How to Get a Home Care Assessment

You've decided your parent needs home care through Missouri Medicaid, but you don't know where to start. The agency that controls access is the Division of Senior and Disability Services (DSDS), operating within the Department of Health and Senior Services. They determine whether your parent qualifies for home-based care instead of a nursing facility — and the process starts with a formal referral and assessment.

Understanding how DSDS works saves weeks of confusion and prevents the most common mistake families make: applying for the wrong program.

What DSDS Actually Does

DSDS doesn't provide care directly. It's the gatekeeper. The division manages Missouri's Home and Community-Based Services (HCBS) programs funded through MO HealthNet (Missouri Medicaid), including:

• Consumer Directed Services (CDS) — allows the participant to hire and supervise their own personal care attendants, including family members in some cases
• Aged and Disabled Waiver (ADW) — provides agency-directed home care, adult day care, and home modifications for people who meet the nursing facility level of care
• Structured Family Caregiving Waiver (SFCW) — pays a live-in family member to provide daily care for adults with Alzheimer's or related dementias (capped at 300 unduplicated slots per waiver year)
• Independent Living Waiver (ILW) — helps adults with physical disabilities live independently through attendant care, assistive technology, and home adaptations

Before your parent can access any of these programs, DSDS must determine that they meet the nursing facility level of care — meaning their medical and functional needs are severe enough that they would otherwise require nursing home placement.

Step 1: Submit an HCBS Referral

The process begins with a formal referral to the Bureau of HCBS Intake. A referral can come from:

• A hospital social worker (common during discharge planning)
• A primary care physician
• The family member themselves
• A home health agency or case manager

The referral form (HCBS-1) is available through the DHSS HCBS portal. You'll need your parent's:

• Social Security number and date of birth
• Active Medicaid eligibility (ME) codes — if your parent isn't yet on Medicaid, the care assessment and Medicaid application happen in parallel, but eligibility must be established before services can start
• Current living situation and primary diagnoses
• Contact information for the legal representative (if your parent has a DPOA or guardian)

After the referral, DSDS schedules the in-home assessment; the workflow estimates 10 to 30 days from referral.

Step 2: The InterRAI Assessment

DSDS uses the InterRAI HC (Home Care) assessment tool — a comprehensive clinical and functional evaluation conducted face-to-face in your parent's residence. This is the single most important step in the process. The assessment determines:

• Nursing facility level of care (NFLOC) — scored by evaluating your parent's Activities of Daily Living (ADLs), cognitive function, behavioral symptoms, and medical complexity. For the CDS program, the InterRAI HC assessment uses a minimum of 18 points for the nursing facility level of care.
• Which programs your parent is eligible for — the assessor matches functional needs to available HCBS programs
• Authorized service hours — how many hours of personal care assistance the state will fund per week

The assessment usually takes 90 minutes to 2 hours. As the family member, you should be present to provide context the assessor might miss — your parent may understate their limitations or perform better during the evaluation than they do in daily life. Specific things to communicate:

• Falls in the past 90 days (frequency, circumstances, injuries)
• Assistance needed with bathing, dressing, toileting, transferring, and eating
• Wandering, agitation, or behavioral symptoms (especially for dementia)
• Medication management problems
• Recent hospitalizations or ER visits

Step 3: The Person-Centered Care Plan (PCCP)

If your parent meets the nursing facility level of care, DSDS develops a Person-Centered Care Plan. This document specifies:

• The type and amount of services authorized (e.g., 30 hours per week of personal care assistance)
• The service delivery model (consumer-directed, agency-directed, or waiver-based)
• Goals tied to the participant's stated preferences — where they want to live, what activities matter to them, what level of independence they want to maintain
• Backup plans for when the primary caregiver is unavailable

The PCCP is signed by your parent (or their legal representative) and reviewed annually, or sooner if there's a significant change in condition.

Where Legal Authority Intersects

Your parent's legal authority documents directly affect which programs they can access. The most important interaction:

If your parent has a court-appointed guardian or conservator, or an activated DPOA that authorizes another person to perform employer duties, they are ineligible for standard CDS — because CDS requires the participant to self-direct their own care. In that case, the family must pivot to the agency-directed ADW, the ILW (which permits a designated representative), or the SFCW (which is compatible with guardianship and POAs but requires a dementia diagnosis and is capped at 300 unduplicated slots per waiver year).

This is why the choice of legal authority document matters before you even contact DSDS. The wrong document can lock your parent out of the most flexible care program.

For the full breakdown of how Missouri's legal authority instruments interact with DSDS programs — including the CDS guardian exclusion and workarounds — the Missouri Power of Attorney & Guardianship Kit maps each document to its program eligibility consequences.

See more Missouri guides →