Getting paid to care for a family member in Missouri
Yes.
In Missouri, a family member can be paid to give care through Consumer Directed Services (CDS) and Structured Family Caregiving Waiver (SFCW). A spouse can be paid through Structured Family Caregiving Waiver (SFCW).
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Medicaid self-directed care
Consumer Directed Services (CDS)
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Who qualifies
Adults 18 or older with a physical disability who can direct their own care, are in active Medicaid status with an appropriate Medicaid eligibility code, meet nursing facility level of care, and have not been involved in Medicaid fraud. You hire, train and supervise your own attendant, and you are the attendant's employer of record.
People who live in a nursing facility, residential care facility or assisted living facility cannot use CDS. A CDS provider agency processes payroll for the attendant on your behalf.
People 21 or older at entry with Alzheimer's disease or a related dementia diagnosed by a Missouri-licensed physician, who live full time in the same household as their primary caregiver, meet nursing facility level of care, and are in active Medicaid status. The primary caregiver must be the live-in caregiver already giving care before the waiver starts, and a qualified substitute caregiver must be named as a backup.
You cannot be enrolled in any other HCBS state plan or waiver service at the same time. The waiver has a limited number of slots each waiver year (July 1 to June 30).
Yes.
Yes. The primary and substitute caregivers may be a non-family member, a family member, or a legal guardian. The provider agency must pay them for the services they give.
Yes.
Yes. A spouse or legal guardian may provide the structured family caregiving service if they are employed by a MO HealthNet enrolled provider agency and live in the same home as the participant. The caregiver is overseen by the agency's licensed nursing staff and must document the services at least daily.
The caregiver cannot have other employment that interferes with the participant's needs. The provider agency gives 8 hours of training specific to the participant.
The waiver pays a daily rate based on 60% of the nursing facility daily rate. The provider agency can keep no more than 35% of it and must pay the primary and substitute caregivers for services given.
Ask for an Initial Referral to Home and Community-Based Services, online with the HCBS Referral form or by phone. If the minimum requirements are met, an assessor calls to schedule a face-to-face assessment in your home. At the assessment, say that you want Consumer Directed Services, where you select, hire, train and supervise your caregiver.
Ask for an Initial Referral to Home and Community-Based Services, online with the HCBS Referral form or by phone. If the minimum requirements are met, an assessor calls to schedule a face-to-face assessment in your home. Ask about the Structured Family Caregiving Waiver. Staff from the Division of Senior and Disability Services confirm the dementia diagnosis with your physician and give you a list of SFCW providers to choose from.
The diagnosis check and provider list come from the HCBS Manual section 3.60. The request goes to the Bureau of Federal Programs, which confirms a slot is open.
