Missouri's Medicaid program, MO HealthNet, offers several paths to help pay for care at home instead of in a nursing facility. This guide walks through eligibility, the application process, and how the main programs differ, so you know what to expect before you start.
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Who qualifies · Spend-down · Program comparison · How to apply · What happens after you apply · Common questions
What is HCBS?
Home and Community-Based Services (HCBS) let MO HealthNet pay for services that help someone stay at home instead of moving to a nursing facility - personal care, homemaker help, respite, adult day care, and more. These are Medicaid waiver and state plan programs, layered on top of regular Medicaid, each with their own eligibility rules. The Missouri Department of Health & Senior Services' Division of Senior and Disability Services (DSDS) administers most of them.
Sources: MO HealthNet Division; DHSS Division of Senior and Disability Services.
Who qualifies
Three things generally have to line up: age or disability status, income and assets under the program's limit, and a functional need for care.
Age / disability
65+ for regular MO HealthNet Aged, Blind & Disabled (MHABD); 63+ specifically for the Aged & Disabled Waiver; any age with a qualifying physical disability for CDS/ILW.
Residency & status
Missouri resident with intent to remain; U.S. citizen or qualifying immigrant.
Income & assets
Limits are set annually and vary by program - as of 2026, regular MHABD uses a Medically Needy Income Limit around $1,130/month individual, with a higher separate limit for the Aged & Disabled Waiver, and an asset limit in the low thousands for a single applicant. A primary home you live in is generally exempt. These exact figures change every year - confirm current numbers at mydss.mo.gov before you rely on them.
Functional need
A DHSS assessment (the InterRAI HC tool) has to show you need help with daily activities at a level that would otherwise require a nursing facility.
Not meeting every figure above doesn't automatically mean you're ineligible - income slightly over the limit is common, and it's what the next section is about.
What is a "spend-down"?
If your income is above the limit for regular MO HealthNet, Missouri lets you "spend down" the excess on medical bills each month to qualify - this is a legitimate, common planning tool, not a loophole. Missouri's spend-down period resets monthly (most states use six months), so bills have to be documented within the same calendar month to count. The Aged & Disabled Waiver uses a separate, higher income limit and generally doesn't require a spend-down.
Comparing the home care programs
You can only be enrolled in one HCBS waiver at a time, so it's worth understanding what each one actually offers before you apply.
MO HealthNet for the Aged, Blind & Disabled (MHABD)
Regular Medicaid for seniors and people who are blind or disabled. Not itself a long-term-care program, but can cover some personal care and adult day services under the state plan.
Who's it for: Anyone 65+, blind, or disabled who meets income/asset limits (or qualifies via spend-down).
Who hires the caregiver: An agency, through the Consumer-Directed or Agency model of State Plan Personal Care.
Aged & Disabled Waiver (ADW)
Missouri’s primary HCBS waiver for older adults. Covers homemaker services, chore services, home-delivered meals, respite care, and adult day care, aimed at preventing or delaying nursing home admission.
Who's it for: People 63+ (or disabled) who need a nursing-facility level of care (NFLOC) but can be safely served at home.
Who hires the caregiver: An approved home care agency - you choose the agency, but the agency employs and supervises the caregiver.
Consumer Directed Services (CDS) & Independent Living Waiver (ILW)
CDS lets you hire, train, and supervise your own attendant - including many family members (not a spouse or legal guardian) - for help with daily activities. The ILW adds services for CDS participants with physical disabilities who need extra support to stay independent.
Who's it for: People with a physical disability who are able to direct their own care and live independently.
Who hires the caregiver: You - the participant is the employer of record; a CDS vendor processes payroll and paperwork on your behalf.
How to apply, step by step
- Apply for MO HealthNet through the Family Support Division - online at mydss.mo.gov, by phone, by mail, or in person at a local FSD office.
- Gather your documents (see checklist below) - missing paperwork is the most common cause of delay.
- Complete the functional needs assessment (InterRAI HC) scheduled by DHSS/DSDS, which determines your level of care and which waiver you qualify for.
- Receive your determination letter and, if approved, choose how you want to receive care - an agency (ADW) or a self-hired attendant (CDS/ILW).
- Enroll with a provider or CDS vendor so services can begin.
Documents to have ready
✓ Photo ID
✓ Social Security card or number
✓ Proof of Missouri residency
✓ Proof of income (Social Security, pension, etc.)
✓ Bank statements (last 2-3 months)
✓ Proof of any life insurance or burial policies
✓ Medicare card, if applicable
✓ Recent medical records or a letter from a doctor describing care needs
What happens after you apply
Federal rules give Missouri up to 45 days to process a standard application (up to 90 days if disability has to be determined), though the full process - application through a waiver determination letter - commonly takes closer to 2-3 months, longer if paperwork is incomplete. Some waivers have enrollment limits and waiting lists, so approval doesn't always mean services start immediately. You'll be notified in writing of approval or denial, and you have the right to appeal a denial.
Common questions
Can I choose my own caregiver?
Under the Aged & Disabled Waiver, no - an agency assigns and supervises the caregiver. Under Consumer Directed Services or the Independent Living Waiver, yes - you hire and direct your own attendant.
Can a family member get paid to be my caregiver?
Not through the Aged & Disabled Waiver alone. Through CDS, many family members can be hired and paid as your attendant - except a spouse or legal guardian, who are excluded by Missouri regulation.
How long does approval take?
Federal rules allow up to 45 days for a standard application (90 for disability determinations), but the full process including a waiver assessment commonly takes 2-3 months. Incomplete paperwork is the most common cause of delay.
Can I switch between programs later?
You can only be enrolled in one HCBS waiver at a time, but you can request a change if your needs or preferences change - talk to your DSDS case manager.
What if my income is slightly over the limit?
Ask about the spend-down option for regular MO HealthNet, or ask whether the Aged & Disabled Waiver’s separate, higher income limit applies to your situation.
Do I need a lawyer to apply?
No, but if you have significant assets, a home, or a spouse who isn’t applying, an elder law attorney can help you understand how those are treated before you apply.
Good to know
If you're approved and need to choose a provider, Caring Companions is an approved Aged & Disabled Waiver agency providing in-home services (IHS), and our sister company, Caring Companions Consumer Directed Services, serves as a CDS/ILW vendor handling attendant payroll. Neither is required to use this guide or apply through MO HealthNet - it applies the same way regardless of which provider, if any, you eventually choose.