Consumer Directed Services vs. Agency Home Care in Missouri

Reviewed October 9, 2026. Missouri families looking for help at home may encounter two different models: Consumer Directed Services (CDS) and agency-directed home care. Both can support daily living, but the person who chooses and manages the caregiver is different.

The short answer

In Missouri CDS, an eligible participant recruits, hires, trains, schedules, and supervises the attendant. A CDS provider supports payroll, taxes, documentation, electronic visit verification, and program administration. In agency-directed care, the agency generally recruits, employs, schedules, and supervises the worker.

CDS compared with agency-directed care

• Who chooses the worker: The CDS participant chooses an eligible attendant; the agency assigns or schedules staff in agency-directed care.
• Who directs the work: The CDS participant directs day-to-day tasks within the authorized care plan; the agency manages its employee under the service plan.
• Family caregivers: CDS may allow a qualified friend or family member, but not a spouse or legal guardian. Agency rules and staffing arrangements differ.
• Scheduling: CDS participants coordinate schedules directly with their attendant. Agency-directed care depends on agency staffing and availability.
• Administration: A CDS provider handles approved payroll and required program administration. An agency manages employment and service delivery for its staff.

Who may prefer Missouri CDS?

CDS may fit an adult with a physical disability who meets Missouri’s eligibility rules, wants to choose a trusted caregiver, and is willing and able to direct that person’s work. It can be especially attractive when a family member or friend is already providing consistent support and could meet the attendant requirements.

Who may prefer agency-directed home care?

Agency-directed care may fit someone who does not have a caregiver to recruit, prefers the agency to handle staffing and supervision, needs backup staffing, or is not comfortable directing an attendant. The exact services, eligibility, payment source, and staffing vary by program and provider.

What Missouri decides

For state-funded services, Missouri determines eligibility, the approved care plan, authorized tasks, and service hours. A provider cannot promise approval or add paid tasks outside the authorization. CDS participants generally must be at least 18, have a physical disability, meet the required level of care, have qualifying MO HealthNet coverage, and be able to self-direct care.

CDS participant responsibilities

CDS gives the participant meaningful control, but also real responsibilities. The participant is the employer of record and must choose an attendant, explain the approved tasks, set the schedule, supervise performance, approve accurate time records, use electronic visit verification as required, and address attendance or performance problems.

What a CDS provider does

A CDS provider such as HomeTeam helps an authorized participant and attendant complete onboarding, payroll, taxes, required records, and EVV-related processes. The provider does not select the caregiver for the participant or decide the state-authorized hours.

Questions to ask before choosing a model

1. Do I have a trusted, eligible person I want to hire?
2. Am I comfortable training, scheduling, and supervising that person?
3. Do I need the provider to supply replacement staff?
4. Which model is available under my coverage and state authorization?
5. What happens if the worker is absent?
6. How are payroll, time corrections, and EVV questions handled?

Frequently asked questions

Can I use CDS and choose any caregiver?

No. The person must meet Missouri program requirements and complete required enrollment steps. A spouse or legal guardian cannot be the paid CDS attendant.

Is CDS the same as skilled home health?

No. CDS is a self-directed personal-care model. Skilled home health involves clinical services ordered and delivered under different rules. A person may have different services at the same time if each is separately eligible and authorized.

Does HomeTeam decide which model I qualify for?

No. Missouri and the applicable payer determine eligibility and authorization. HomeTeam can explain the provider process and help you understand the questions to ask.

Talk with HomeTeam

Call (844) GET-1525 or contact HomeTeam to discuss Missouri CDS and agency-directed options. We will explain what HomeTeam offers and help you identify the next appropriate step.

Official sources

• Missouri DHSS Home and Community-Based Services Manual
• Missouri DSS Consumer Directed Services information

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