Missouri CDS: Consumer Directed Services Guide

If you're caring for an aging or disabled loved one in Missouri, you may not realize the state has a program that can pay someone you trust to provide that care. It's called Consumer Directed Services, or CDS, and it's one of the most valuable and least understood benefits available to Missouri families.

What Is Consumer Directed Services (CDS)?

CDS is Missouri's self-directed Medicaid personal care program. It runs through MO HealthNet and is overseen by the Department of Health and Senior Services. The idea is simple: an agency doesn't assign a stranger to provide care. Instead, the person receiving care hires, trains and supervises their own caregiver. That caregiver can be someone they already know and trust, like an adult child, a sibling, a close friend or a neighbor.

Who Is Eligible?

To qualify for CDS, the person receiving care generally must:

• Be 18 or older
• Be eligible for Missouri Medicaid (MO HealthNet)
• Have a physical disability
• Be able to direct their own care
• Be able to live independently with CDS support
• Be assessed as needing at least a nursing-facility level of care

People who live in a nursing facility, a residential care facility or an assisted living facility are not eligible for CDS while they live there.

Eligibility is decided in two parts. The Division of Senior and Disability Services (DSDS) evaluates care needs, and the Family Support Division handles Medicaid financial eligibility. Our eligibility checklist walks through each requirement in plain language.

Who Can You Hire as a Caregiver?

This is where CDS really stands out. You can hire the caregiver of your choice, whether that's an adult child, another relative or a friend. Two people cannot be the paid caregiver: your spouse and your legal guardian. Outside of that, the flexibility is a big reason many families choose CDS over a traditional home care agency.

Caregivers still go through the state's screening, which includes a background check and registration with the Family Care Safety Registry. To read about who can be paid, see our guide to paid family caregivers in Missouri. If you want to be the caregiver, see how to become a CDS caregiver in Missouri.

What Can a CDS Caregiver Do for You?

CDS is about staying where you are most comfortable: in your own home, in your own routine, with someone you trust beside you. Depending on your approved care plan, your caregiver can help you start the day with bathing, dressing and grooming, move safely around the house, and sit down to a home-cooked meal. It is care that fits your life, from someone who already knows how you like things done. The specific tasks and the number of hours come from your state assessment and care plan, so you always know what to expect.

How Does the Process Work?

1. Confirm Medicaid eligibility. The person receiving care needs MO HealthNet coverage.
2. Complete a state assessment. DSDS evaluates the level of care needed.
3. Choose your caregiver. The consumer picks who they want to hire.
4. Work with a CDS vendor. The vendor handles the caregiver's payroll, taxes and paperwork, while the consumer stays in charge of the care.
5. Care begins. Once everything is approved, the caregiver starts providing services and is paid on a regular payroll schedule.

To start the state's side of the process, use the official DHSS page on applying for home and community based services. For a step-by-step walk-through, see our guide to applying for CDS in Missouri.

What Does a CDS Vendor Do?

The CDS vendor is the business that handles the employer paperwork so that you can focus on care. That includes running payroll, handling payroll taxes, keeping the required documentation, and helping you use the state's electronic visit verification (EVV) system. You still decide who works for you and how the schedule runs. Our article on what a Missouri CDS vendor does goes into detail, and our checklist for choosing a CDS provider lists what to ask before you decide.

How Do Caregivers Get Paid?

CDS services are funded by Missouri Medicaid, so there's no cost to the person receiving care for approved hours. Caregivers are paid through the CDS vendor's payroll. Caregivers don't need special certifications to take part, and most vendors provide training on the required steps. Caregivers must be at least 18 and eligible to work in the United States. Pay rates are set by the state and can change, so check our article on caregiver pay in Missouri for the latest.

How Is CDS Different From a Home Care Agency?

With a traditional agency, the agency assigns and manages the caregiver. You may not get much say in who comes to your home, and staff can change often. With CDS, you choose who provides care, you help set the schedule, and the relationship is one you already trust. The trade-off is more coordination, which is exactly where an experienced CDS agency like HomeTeam makes the process easier.

Is CDS the Same as CDPAP?

No. CDPAP is New York's program. Missouri's version is called CDS, and the rules are set by the state. If you searched for CDPAP, read what CDPAP means in Missouri.

Common Questions

Who runs CDS in Missouri? The Division of Senior and Disability Services (DSDS) within the Missouri Department of Health and Senior Services oversees it, as part of MO HealthNet.

Can my spouse be my paid caregiver? No. Under Missouri CDS, neither a spouse nor a legal guardian can be the paid caregiver. Other relatives and friends can be, if you are eligible.

Can I use CDS if I live in assisted living or a nursing home? No. People who live in a nursing facility, residential care facility or assisted living facility are not eligible for CDS while they live there.

Do I need to be on Medicaid? Yes. CDS is a Medicaid program, so you need to be eligible for MO HealthNet.

Where do I start? Read our eligibility checklist, then start the state referral on the DHSS page above. If you would like help understanding the steps, call HomeTeam.

How HomeTeam Can Help

Eligibility paperwork, assessments and payroll setup can feel overwhelming on your own. HomeTeam walks Missouri families through the entire CDS process, from finding out whether a loved one qualifies to getting their chosen caregiver hired and paid.

Ready to find out if you or a family member qualifies for CDS in Missouri? Get started with HomeTeam or call (314) 863-5987.