Consumer Directed Services (CDS) in Missouri — How It Works in St. Louis

    Consumer Directed Services lets a Missouri adult with a disability hire and direct their own personal care attendant — often a relative — instead of being assigned a caregiver by an agency. Diverse Health Services helps St. Louis families understand the program. This page explains the program, the three roles in it, who decides eligibility and how to get started.

    How to apply for CDSCall 314-667-5951

    What CDS is

    Consumer Directed Services is one of Missouri's Home and Community Based Services (HCBS) — the state's programs that help older adults and people with disabilities live in their own homes and communities rather than moving to a nursing home or other institution. HCBS are administered by the Missouri Department of Health and Senior Services (DHSS) through its Division of Senior and Disability Services (DSDS), which takes referrals, assesses each person's level of care and authorises services through a person-centered care plan.

    CDS is the self-directed option within that system. DHSS's application page describes the choice at the assessment: the "Agency Model", where a provider hires the caregivers, or "Consumer Directed", where you hire them. The program sits within Missouri Medicaid (MO HealthNet), so active MO HealthNet coverage is one of the state's requirements.

    In plain terms: the participant becomes the employer of their attendant, the state decides who is eligible and how many hours are authorised, and the vendor takes care of the payroll, paperwork and oversight the program requires. Nothing on this page replaces the state's own rules; the sources we relied on are listed at the end.

    The three roles in CDS

    The participant

    The person receiving care. In CDS the participant is the attendant's employer of record: they choose, train, schedule and supervise their attendant and sign the timesheets. DHSS's manual puts it simply — participants can exercise individual choice in deciding who provides their CDS.

    The attendant

    The person who does the personal care tasks in the care plan. DHSS says the attendant may be a family member, but cannot be the participant's spouse or legal guardian, and the attendant must clear the state's background screening and be registered with the Family Care Safety Registry.

    The vendor — the administrative side

    An organisation with a written agreement with DHSS. Missouri statute sets the vendor's duties: orientation on being an employer, help recruiting and training an attendant, registry checks, verifying timesheets, paying the attendant on the participant's behalf, paying the payroll taxes and visiting at least once a year to see how services are going.

    What we do not do is just as important. Diverse Health Services does not decide who is eligible and does not set the number of hours in a care plan. Those are the state's decisions, made through DSDS and the care plan.

    Who the program is for

    Missouri's statute on consumer-directed personal care assistance lists who the program is designed for: a person who is eighteen or older and physically disabled, who is able to direct their own care, who can document MO HealthNet (Missouri Medicaid) eligibility, and whose unmet needs can be met safely at home at a cost that does not exceed what MO HealthNet (Missouri Medicaid) would pay for nursing-facility care. DHSS's own pages add that your care needs have to be equal to nursing home care and that an in-person assessment establishes that.

    DHSS/DSDS — not Diverse Health Services — determines eligibility. We can explain the steps and what to have ready, but the assessment and the decision belong to the state.

    How to get started

    1. 1

      Submit a referral to the state. DHSS accepts HCBS referrals online or by phone at 1-866-835-3505. Participants, family, friends and other informal supports can all make the call.

    2. 2

      The assessment. If the minimum requirements are met at referral, the DSDS assessment team schedules a face-to-face visit to evaluate the level of care and unmet needs. This is where you say you want the consumer-directed model and name a backup plan.

    3. 3

      Choose a vendor and an attendant. Participants choose who provides their CDS. The vendor then handles orientation, the attendant's registry check and the payroll set-up.

    Read the full step-by-step guide to applying for CDS in Missouri

    Already in CDS?

    Switching CDS providers

    What a change of vendor involves — the state's change request, the new vendor's enrolment steps and keeping your attendant where the rules allow.

    Getting paid as a family caregiver

    Who can be the attendant, the screening and registry steps, and how timesheets and payroll work through the vendor.

    Service area

    Diverse Health Services provides non-medical in-home care across St. Louis City, St. Louis County and St. Charles County from one office at 813 N. Kingshighway Blvd., St. Louis, MO 63108, and can talk you through Missouri's CDS program. The service area page lists the counties, how visits are arranged and the area agencies that serve each county.

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    Frequently Asked Questions

    Common Questions About Missouri CDS

    Program questions answered from the state's own sources; your coordinator can explain the rest.

    The vendor is the administrative side of self-directed care. By Missouri statute it provides orientation on employer responsibilities, keeps a list of available attendants, makes sure attendants are registered with the Family Care Safety Registry, verifies timesheets, pays the attendant on the participant's behalf, pays payroll taxes and makes at least one face-to-face visit a year. The participant stays in charge of the care itself.

    Find a CDS provider in St. Louis

    Yes, with limits: DHSS says you can hire anyone except a legal spouse or guardian to be your caregiver, and the attendant must pass the state's background screening before program funds pay for their hours.

    Getting paid to care for a family member

    DHSS/DSDS — not Diverse Health Services — determines eligibility. The Division of Senior and Disability Services takes the referral, carries out an in-person assessment of your level of care and unmet needs, and authorises services through a person-centered care plan. A vendor cannot approve, deny or speed up that decision.

    How to apply for CDS in Missouri

    No. CDS is personal care assistance with everyday activities, directed by the participant and delivered by an attendant the participant chooses. It is not skilled home health care, and Diverse Health Services is a non-medical home care agency.

    Yes. Participants choose who provides their CDS, and a change is requested through the state's HCBS Intake and Person-Centered Care Plan team by phone or through the online change-request form; your provider can also submit the request on your behalf.

    How switching CDS providers works

    We serve St. Louis City, St. Louis County and St. Charles County from our office at 813 N. Kingshighway Blvd., St. Louis, MO 63108.

    See our full service area

    Sources

    Program statements on this page are summarised from the official Missouri sources below. Program rules can change; the state's own pages are the authority.