Missouri CDS: What You Must Do to Direct Your Own Care

CDS participants act as the employer of their caregiver. See what the state requires, and what happens if someone can't direct their own care.

Missouri's Consumer Directed Services (CDS) program is built around one idea: the participant directs their own care. That's a real responsibility, and it's one of the main eligibility requirements. This page explains what the state expects and what happens if a person can't meet it.

What "Directing Your Own Care" Means

The state defines "consumer directed" as hiring, training, supervising and directing the personal care attendant. The state's policy says a participant must be able to:

Supervise the attendant
Verify the wages paid to the attendant
Use Electronic Visit Verification (EVV) correctly
Tell the state about changes that affect the care plan or where the participant lives
Report problems with the quality of the attendant's work to the vendor
Report significant changes in their health or ability to direct their care

The participant is the attendant's employer. The CDS vendor, an enrolled company, receives payment from the state on the participant's behalf and handles payroll.

Who Qualifies, in Brief

The state lists these requirements: be 18 or older, have a physical disability as defined by the state, be able to direct your own care, have active Medicaid, meet nursing facility level of care, and not have been previously involved in Medicaid fraud. See Missouri CDS Eligibility and How to Apply.

How the State Decides Whether Someone Can Direct Their Care

The state's policy says staff may look at:

The person's answers to questions during the assessment
A set of self-direction questions
A short memory and thinking exam called the SLUMS
Statements from the person's healthcare professional about any limits on directing their own care

If another person speaks on the participant's behalf during the assessment, the state documents that.

What Happens If Someone Can't Direct Their Own Care

The state's policy says that if, after a full review, a person can't direct their care, the state follows its adverse action process and tells the person (or their authorized representative) about other options, including agency-based personal care services. The person can appeal the decision.

Do Guardians and Conservators Matter?

The policy says a person with a guardian or conservator can't be turned down for CDS only because of that. But the policy also says the attendant can't be the participant's legal guardian.

What CDS Doesn't Cover

According to the state's policy, CDS doesn't pay for services whose main benefit goes to the whole household, tasks that household members would normally share, or tasks that must be done or taught by a licensed professional, such as skilled nursing.

How HomeTeam Can Help

HomeTeam is a Missouri Consumer Directed Services (CDS) vendor based in Ballwin. CDS is a Medicaid program that lets eligible participants choose their own caregiver, including a family member in many cases, and HomeTeam handles the payroll and paperwork. If you're not sure whether you or a loved one could direct your care, call HomeTeam at (314) 863-5987 and we'll explain your options.