As a Missouri resident, you or your family member might be eligible to take advantage of Consumer Directed Services (CDS), a program through Missouri State Medicaid designed to help adults with physical disabilities take control of their own home care needs. In this guide, we’ll look at the CDS program, how it works, and how it can benefit Missouri residents.

Consumer Directed Services (CDS) is a program through Missouri Medicaid and is designed to assist people living with physical disabilities. The program arranges care services from a personal care attendant (PCA), allowing the care recipient to live in their own homes and communities as opposed to a nursing home. The Consumer Directed Services program is administered by Missouri’s Home and Community Based Services (HCBS), a division of Missouri’s Department of Health and Senior and Services (DHSS),

What is Consumer Directed Services (CDS)?

The idea behind self-directed or consumer-directed services is to let the consumer (i.e., the patient) direct their own caregiving needs as opposed to living in a nursing home and having their needs overseen by others.

What are self-directed services?

The most significant benefit of the Missouri CDS program is that the care recipient gets to live in an environment in which they are comfortable, despite their disability. Like many people, you might not want to move into a nursing home, separated from your community.

Another benefit of CDS is that you are allowed to hire friends or family members to provide you caregiving services. The only exception is that they cannot be your spouse or legal guardian. By allowing you to hire a caregiver of your choice, CDS makes it possible for you to receive care from someone you like and trust, instead of a stranger at a nursing home.

Also, when a personal care assistant helps you with daily living activities, you will be able to live on your own and pursue activities that otherwise might not have been possible due to your disability. You can continue working, going to school, or engaging with your neighbors and community.

Finally, if you’re a caregiver, CDS allows you to earn money while you provide care for a friend or family member (except a legal spouse). The extra income could be ideal if you’re seeking part-time work or if you’re retired.

What are the benefits of Consumer Directed Services (CDS)?

To qualify for CDS, you would have to be deemed eligible by Missouri’s Division of Health and Senior Services (DHSS). One of the prerequisites of CDS is that you must be currently on MO HealthNet, which is Missouri’s Medicaid program. If you’re not presently enrolled in MO Healthnet, please visit our Medicaid section for more information on how to enroll.

As a participant in the CDS program, you will hire, train, and direct your caregiver. The specific tasks your care assistant helps you with will vary based on your needs and according to your disability and living arrangements. However, here are some of the typical things that you can expect your assistant to help you with:

<ul class="faq__list-unordered"><li>Grooming</li><li>Bathing</li><li>Personal hygiene</li><li>Toilet use</li><li>Mobility</li><li>Taking medications on time</li><li>Cleaning</li><li>Laundry</li><li>Cooking</li><li>Shopping</li><li>Essential transportation</li></ul>

Your personal care assistant (PCA) will be compensated by Emerest. As mentioned above, you can hire your friends or family members as caregivers.

How does Consumer Directed Services (CDS) work?

CDS is intended for people who have difficulty performing daily activities due to physical disabilities or illness.

Here are the requirements to be eligible for CDS:
<ul class="faq__list-unordered"><li>Missouri resident above the age of 18</li><li>Have active Missouri Medicaid coverage. </li><li>Have a physical disability that makes it very difficult to perform activities of daily living (cleaning, cooking, bathing etc.)</li><li>Be capable of self-directing your care.</li></ul>

Am I eligible for the Consumer Directed Services (CDS) Program?

Choosing the right personal care assistant (PCA) for yourself or a loved one can be a challenging task. Through CDS, you can hire someone you already know and like, such as a friend or family member. However, it still makes sense to think it through and pick someone who will be a good fit for the job.

Here are a few things you should keep in mind when hiring a PCA:
<ul class="faq__list-unordered"></ul><li>Understanding– Make sure your PCS has a solid understanding of all the tasks they would be helping you with. Also, make sure they are adequately capable of helping you with these activities. </li><li>Compassion – Try to find a PCA who has some relevant experience. Individuals who have helped others in the past will be more likely to understand your needs and provide care accordingly.</li><li>Agreement– For the consumer-PCA relationship to thrive, it must fit the lifestyle of both the patient and caregiver.</li></ul>

What to look for in a personal care assistant (PCA)?

For more information on the CDS program or to switch your CDS to Emerest, contact Emerest and a representative will happily answer all your questions. You can reach us at <a href="tel:+18339372912">833-937-2912</a> or by filling out our online contact form.

Next Steps

a beginner’s guide to cds

Personal Care for People with Disabilities Through the Decades: A History of the Evolution of the Consumer Directed Model for Care

Pre-1970s – Widespread Exclusion of People with Disabilities

The possession of a disability was widely equated with the need for institutionalized care, especially for individuals without significant family support systems in place. Independent living as a disabled person was not thought to be possible.

1945-1970 – Assistance for Veterans

The US Department of Veterans Affairs instituted a program for disabled veterans to hire personal attendants to help them with day-to-day activities.

1953 – Rancho Los Amigos Medical Center in Los Angeles

In an effort to minimize costs, this California medical center hired personal assistants for 158 iron lung users and paid $10/day as it was cheaper than inpatient care which cost $37/day.

In 1973, this program developed into the California In-Home Support Services Program

1960-1970s – Independent Living Movement

People with disabilities pushed for equal involvement in society and mainstream events. Nursing homes and institutions were unnecessary and expensive, but no other options existed in the form of personal care services. The help needed was on a basic level, but no formal organization existed for facilitation of services and caregivers.

1960 – UC Berkeley Self-directed Program

Small programs sprang up as the Independent Living Movement gained traction. Ed Roberts and other disability rights activists began small self-directed care programs around the country.

1972 – Center for Independent Living

The CIL began at the University of California at Berkeley campus, founded by Ed Roberts, Hale Zukas, and Jan McEwan. The center made all of academic and social life on campus accessible to all students.

1973 – Rehabilitation Act of 

The Rehabilitation Services Administration was established to provide grants for Independent Living Centers, vocational rehabilitation, personal care assistance, as well as disability supportive employment services. This legislation represented a big push for civil rights for people with disabilities.

This was later replaced by the Americans with Disabilities Act in 1990.

1981 – Omnibus Budget Reconciliation Act

Home and Community Based Services are permitted as an alternative to institutionalized care under the 1915(c) waivers, covered by Medicaid. Section 1115 waivers operated to waive service and eligibility requirements to allow the development of demonstration projects.

1985 – Non-Medicaid Eligible Program

This was the first self-directed care program in Missouri and was created so that disabled people could become employed without having to spend all their time on daily tasks. Through the Department of Vocational and Rehabilitation Services, the state funded personal care attendants for eligible members.

1990 – Americans with Disabilities Act

This legislation prohibited the discrimination against people with disabilities in any setting, including public accommodations, schools, miscellaneous provisions, and areas of employment.

1992 – Clinton Administration Task Force on Health Care Reform

This reform included a self-directed care option, as well as establishing the National Institute on Consumer Directed Long Term Services

1993 – Personal Assistance Services (PAS) Program

Under the oversight of Vocational Rehabilitation, this program was created in Missouri for disabled persons to hire their own attendant and direct their own care; this lead to the opportunity for these people to lead more active lives, while also providing a cheaper alternative to nursing home care.

1995 – New Programs for Disabled Person Empowerment

Self-Determination Program: this program was specifically for people with intellectual and developmental disabilities, and 18 states received grants to begin their own self-directed care programs.

Independent Choices Program: this program was specifically for seniors and young people with disabilities.

1997 – Balanced Budget Act

In a large advancement for self-determination and community engagement for disabled people, Medicaid Buy-In permitted states to cover people with disabilities to work without losing their Medicaid benefits. The states were also allowed to cover habilitation services in institutional and home settings.

1998 – The Robert Woods Johnson Foundation (RWJF) and Health and Human Services (HSS) Partner Up

Together these programs launched the Cash and Counseling Demonstration Program which reduced the unmet needs of Medicaid participants in need of PAS and improved their quality of life. Demonstration patients received more of the care they were authorized to receive, and institutional costs for Medicaid were reduced.

1999 – Supreme Court Case: Olmstead v. L.C.

The Court granted disabled people the right to live in communities rather than institutions, and pressured states to find alternatives to nursing home care for these people.

1999 – Ticket-to-Work and Work Incentives Improvement Act

Benefits planning and assistance was provided for states to allow coverage for people with disabilities who are employed and might otherwise lose their Medicaid or Medicare coverage.

2000 – National Family Caregiver Support Program

This program covered care by informal family caregivers, including assistance with counseling services, caregiver training, respite care, and some supplemental services for members.

This required an update of the Older Americans Act of 1965

2000 – Missouri Independent Living Waiver (ILW) Instituted

The ILW allowed for a greater number of assistance hours, as well as the purchasing of medical equipment and environmental accessibility adaptations.

2001 – New Freedom Initiative

The Independence Plus Program and Real Choice Systems Change/Aging and Disability Resources Center Grants were both included in this initiative, which funded disabled people to engage in their respective communities more easily.

2005 – Deficit Reduction Act (DRA)

A competitive grant program was founded to further push states towards instituting home and community-based care for people with disabilities. A higher matching rate was provided for non-institutional care services, and more types of expenditures were covered.

2005 – Department of Health and Senior Services in Missouri renames PAS as the Consumer Directed Services (CDS) Program

Anyone is allowed a contract to apply to be a CDS vendor.

2015 – Emerest Consumer Directed Services opens and begins serving thousands of patients across the state of Missouri

Present Day – There are over 45,000 people enrolled in CDS in the state of Missouri.

Сonsumer Directed Services (CDS) 101

A BEGINNER’S GUIDE TO CDS

THE HISTORY OF CONSUMER DIRECTED SERVICES (CDS)

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