Consumer Directed Services in Missouri: who can be your attendant

Missouri Consumer Directed Services (CDS) let you hire and direct your own attendant for personal care. The Department of Health and Senior Services (DHSS) manual says spouses and court-appointed guardians or conservators cannot be the paid attendant, and a minor cannot be hired.

What CDS is

Missouri Medicaid Audit and Compliance (MMAC) lists CDS tasks as personal care (bathing, grooming, dressing, personal hygiene), toileting such as ostomy or catheter hygiene and bowel or bladder routines, manual help with medications and treatments, housekeeping, meal preparation and help with eating, and essential shopping and errands, including trips for school or employment. MMAC says funding comes from Medicaid through the MO HealthNet Division and from General Revenue through DHSS and the Division of Senior and Disability Services (DSDS), and that DHSS and DSDS or its designee authorizes the services.

The program is one of the self-directed options in Missouri. For the wider picture see the Missouri program overview.

Who qualifies

The DHSS manual chapter on Medicaid eligibility, revised February 2026, says applicants for home and community based services need an appropriate Medicaid eligibility code, must meet nursing facility level of care, and must agree to a face-to-face assessment and a person-centered care plan. It says people with Medicaid Expansion code E2 are eligible only for CDS. The CDS clarification page adds that the participant must have the ability to self-direct their own care. Holding a power of attorney does not disqualify a participant.

We did not read the pages that set out the age or disability requirements, so we do not state them. Ask DSDS.

Who can be your attendant

DHSS's CDS clarification says:

• spouses cannot be the paid CDS attendant;
• legally responsible individuals, meaning a court-appointed guardian or conservator, are prohibited;
• a payee may be an attendant, though the provider may want more oversight;
• a minor cannot be hired, even with caregiving experience; and
• an agency owner or direct employee who performs certain office tasks cannot be an attendant for that agency's participants, except on a temporary basis on no more than three days in a thirty-day period.

The page says "only" legally responsible individuals and spouses are prohibited, and it defines the first group as a court-appointed guardian or conservator. It does not name other relatives, so we do not say whether a parent of a minor child can be paid. Ask DSDS.

How the rules work in practice

• Start of service. The manual says no timeframe is set in statute or regulation for CDS, and the provider keeps a list of eligible attendants for participants who need immediate care.
• One attendant at a time. Two attendants cannot work in the home at once under the same service code, because of the one service code per participant at one time requirement for Medicaid billing.
• Out of state. An attendant may give care out of state, but the travel must be temporary.
• Employer number. Services cannot begin until the CDS agency gets an employer identification number and uploads it to the participant's record.
• Other programs. A participant cannot be in both CDS and the Department of Mental Health's Self-Directed Services.
• Not covered. Dialysis tasks are beyond the scope of personal care and cannot be authorized.

Pay

We did not find a wage or rate on the pages we read. Ask the CDS agency and DSDS.

Where to start

1. Ask DHSS Senior and Disability Services for an assessment. The pages we read give no intake number. The Department of Social Services is listed at 573-751-3425 on Medicaid.gov for coverage questions.
2. Ask whether you meet nursing facility level of care.
3. Ask which CDS agencies serve your area and who they would hire.

See also paid family caregiver in Missouri, home care in Missouri, home health in Missouri, nursing homes in Missouri and developmental disability services in Missouri.

Carevo is a connection platform and directory. We do not run CDS, decide eligibility or set pay.

More about care in Missouri

• All Missouri Medicaid programs for care at home
• Paid family caregiver in Missouri
• Home care providers in Missouri