Missouri Level of Care Assessment: How the InterRAI Scoring Works

Every Missouri senior who wants state-funded home care — whether through Consumer Directed Services, the Aged and Disabled Waiver, or the Structured Family Caregiving Waiver — must first pass the state's level of care assessment. This single evaluation determines whether your parent qualifies for any Medicaid-funded services at home. Understanding how the scoring works helps families prepare for the assessment and ensures the evaluator captures the full extent of a parent's care needs.

The InterRAI Home Care Assessment

Missouri uses the InterRAI Home Care (HC) tool, administered by the Division of Senior and Disability Services (DSDS) during a mandatory face-to-face visit in your parent's home. A DSDS coordinator observes your parent, interviews them and any family members present, and scores their functional limitations across 12 clinical categories.

The InterRAI system runs proprietary algorithms to produce a composite score. To qualify for any HCBS program in Missouri, your parent must score a minimum of 18 points — the threshold that demonstrates a nursing facility level of care.

The 12 Scoring Categories

Each category has a maximum point value, and several include automatic 18-point triggers for the most severe impairments:

Cognition (max 18 points): Measures decision-making and communication capacity. No impairment scores 0; moderate confusion scores 3-6; severe and consistent disorientation scores 9. A comatose state triggers an automatic 18 points.

Mobility (max 18 points): Evaluates walking/wheeling and bed mobility. Limited physical assistance (less than 50% weight-bearing) scores 3; maximum weight-bearing assistance scores 6. Total dependence on others for locomotion or being entirely bedbound triggers 18 points.

Eating (max 18 points): Covers physical eating capability and therapeutic diets. Independent eating scores 0; a physician-ordered diet or setup assistance scores 3; moderate assistance scores 6; maximum assistance scores 9. Total feeding dependence (including tube feeding) triggers 18 points.

Toileting (max 9 points): Measures assistance needed for toilet use, incontinence management, catheter/ostomy care, and transfers. Independent scores 0; limited help scores 3; maximum assistance (2+ helpers or more than 50% weight-bearing) scores 6; total dependence scores 9.

Bathing (max 6 points): Covers transfers and body washing. Independent or setup-only scores 0; limited to moderate help scores 3; maximum assistance or total dependence scores 6.

Dressing and Grooming (max 6 points): Evaluates personal hygiene, upper body, and lower body dressing. Independent scores 0; limited/moderate help scores 3; maximum assistance scores 6.

Behavioral (max 9 points): Assesses wandering, physical aggression, public disrobing, delusions, and hallucinations. Stable conditions score 0; monthly monitored conditions score 3; actively exhibited symptoms score 6; unstable psychiatric conditions requiring active monthly monitoring alongside behavioral symptoms score 9.

Treatments (max 6 points): Binary scoring — if the applicant requires catheter/ostomy care, alternate nutrition (TPN/tube feeding), suctioning, ventilator use, or active clinical wound care, the score is 6. Otherwise, 0.

Rehabilitation (max 9 points): Based on frequency of ordered therapies (PT, OT, speech, cardiac rehab). No therapy scores 0; once weekly scores 3; two to three times weekly scores 6; four or more times weekly scores 9.

Meal Preparation (max 6 points): Evaluates independent living skills for preparing food. Independent or setup-only scores 0; limited/moderate help scores 3; maximum assistance or total dependence scores 6.

Medication Management (max 6 points): Assesses ability to prepare and take medications safely. No assistance scores 0; setup or supervision scores 3; maximum assistance or total dependence scores 6.

Safety (max 18 points): Evaluates vision, balance, and fall history. No issues score 0; severe vision loss, balance problems, or a fall in the past 90 days scores 3; blindness or a fall combined with active balance issues scores 6. Automatic 18-point triggers activate when specific combinations of age (75+), institutional history, and safety concerns are present.

Preparing for the Assessment

The assessment happens in your parent's home, and the evaluator scores what they observe and what family members report. Families often underscore their parent's needs by compensating during the visit — cleaning up before the assessor arrives, answering questions for the parent, or downplaying safety concerns. This works against your parent's interests.

Be honest about bad days, not just good ones. If your parent wanders at night, falls regularly, or can't manage medications without constant supervision, the assessor needs to hear it. Bring documentation: hospital discharge papers, medication lists, records of falls or ER visits, and any physician notes about cognitive decline.

Have the right people present. The primary family caregiver should be there to describe the day-to-day reality. If your parent has a documented dementia diagnosis, bring the diagnostic paperwork — it's required for SFCW eligibility and can affect multiple scoring categories.

Don't clean up the evidence. If your parent's home has safety hazards — cluttered hallways, broken grab bars, expired food in the refrigerator — those conditions are relevant to the safety and meal preparation scores. Presenting a tidied version of reality can push the composite score below the 18-point threshold.

What Happens After the Assessment

If your parent scores 18 or above, DSDS works with the family to develop a Person-Centered Care Plan (PCCP) specifying the services authorized, the number of weekly hours, and the care delivery model. If the score falls below 18, the applicant doesn't qualify for Medicaid-funded home care, though they may still access services through their Area Agency on Aging funded by the Older Americans Act.

The assessment can be repeated if your parent's condition deteriorates. A new referral through the HCBS line at 866-835-3505 triggers a reassessment.

The Missouri Home Care & Waivers Guide includes the complete InterRAI scoring breakdown and a preparation checklist for the in-home assessment.

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