Missouri Frequently Asked Questions

CDS is a Medicaid-funded program that allows disabled or elderly people in Missouri to hire the caregiver of their choice to help with daily activities. This caregiver, or personal care attendant (PCA), can be a friend, a neighbor, or a family member other than a spouse or legal guardian. A PCA can help with daily chores or hygiene, including:

• Help with cooking, cleaning the house, doing laundry, or taking medications on time.
• Assistance with bathing, dressing, using the bathroom, or other personal hygiene tasks.
• Support on errands or appointments, or general help with mobility.

This service is administered by the Missouri Division of Health and Senior Services (DHSS), and it’s available to eligible adults over the age of 18. The goal of this program is to help participants live independently and choose someone they trust to provide them with care. Participants are responsible for hiring and managing their own attendants. What this means is that if you are in need of extra assistance in your home, and you qualify for CDS, you may hire your own personal care assistant. The friend or family member you hire will be compensated through Emerest.

We are a homecare agency that works with Missouri’s Consumer Directed Services (CDS) program. Emerest Health pays the highest wages for CDS in Missouri and enables you to hire the caregiver of your choice. In addition to CDS, Emerest also provides other Home and Community Based Services through Missouri Medicaid, such as: In-Home Services, Independent Living Waiver (ILW) Services, and Structured Family Caregiver Waiver (SFCW) services.

Self-directed services allow the consumer to instruct the caregiver on how to give them the best possible care. Because the consumer knows exactly what they need, this model of care allows them the freedom to hire or fire whomever they choose to suit their needs. The consumer is expected to hire and train their own caregivers to help them perform daily tasks such as laundry, taking medications on time, or cooking. Also, because this is a Medicaid funded program, the consumer does not need to worry about any medical bills. Provided they meet the program qualifications listed below, this is a 100% free service.

This program began in the mid-90s and underwent a few shifts and name changes to become CDS. In 1993 a program was started under the oversight of Vocational Rehabilitation. Titled Personal Assistance Services (PAS), it was funded by Medicaid and was meant to support people with disabilities. In 2005, the Missouri Department of Health and Senior Services (DHSS) took ownership of this program, renaming it Consumer Directed Services (CDS). A major reason for this change was that the program had shifted away from a focus on employment and grown into a more general personal care program that was home and community based. The DHSS offered vendors the opportunity to serve the CDS program; within 10 years, there were several companies helping to match caregivers with elderly or disabled people. In 2023, the state of Missouri reported that over 45,000 people were enrolled in the CDS program.

We’re excited about this program because of the many benefits it offers members of our community:

• CDS allows elderly or disabled people to remain in their own homes and communities rather than having to seek institutional care or move to an assisted living facility or nursing home.
• The program allows people to choose caregivers that they know and trust.
• With CDS, many family members who would be caring for their loved one anyway can get funding.
• Because the money is provided by Medicaid, participants do not need to worry about payments at all.
• CDS promotes healthier communities and allows elderly and disabled people to live with more independence.

Essentially, CDS allows people to stay at home where they are most comfortable, direct their own care, and choose a caregiver they trust. Plus, the personal care assistant receives weekly compensation, which helps regular Missourians make ends meet.

No! Emerest is free for all Medicaid patients. If you qualify for CDS you will not be charged any fees. This program is funded by Medicaid, so you never have to worry about paying us.

It is important that you choose a caregiver you know and trust, as this can be a challenging task for both individuals that requires a lot of communication. Most consumers hire a friend or family member, as these people will likely already know about your needs and your daily routine. A good candidate to become your PCA is:

• Understanding and communicative – Your caregiver should be open and willing to take instruction from you, their employer, about relevant duties. There should be an open line of communication between the caregiver and consumer, and a mutual respect.
• Experienced – Whether or not they have official caregiving experience, if they have ever helped you in the past they would be better suited to this job as they have already seen your specific care needs. This person could also have experience caring for their own family member or friend in the past.
• Readily Available – If your potential candidate already works a full-time job, they may not be suited to help you with your day-to-day tasks. People who work part-time, are not currently employed, or are students would be able to take on this job as it typically requires 4 hours per day on average. The workload must fit into their life so that they can adequately provide your care.

The Personal Care Assistant (PCA) is compensated at an hourly rate. The current maximum number of hours per month that a CDS participant may receive is approximately 120. So, a participant may be eligible to receive up to approximately 4 hours per day, depending on the number of days in each month and each individual’s personal care needs. In addition to CDS, participants may be eligible for the Independent Living Waiver (ILW) program which may significantly increase their overall hours, depending on their individual needs. This entire program is funded through Medicaid, so there are no extra bills to pay. The person in need of care effectively hires the PCA, and they are paid through a CDS provider like Emerest. Please note, the PCA is not an employee of Emerest. Rather, the PCA is an employee of the CDS participant. Emerest serves as a fiscal intermediary, and we make sure all of your taxes and services are compliant with Missouri state regulations. We also handle payroll for our clients and their caregivers, to ensure that the caregivers are compensated accurately and in a timely manner. Our payroll runs from Sundays to Saturdays, and we pay our caregivers weekly on Thursdays.

Yes, you can get paid to take care of your family! You can get paid to care for an elderly parent or other family member. However, spouses are not eligible. For example, a wife cannot get paid to care for her husband. If your elderly or disabled family member lives in Missouri and qualifies for Consumer Directed Services, Emerest will pay you to care for them. Contact us today at 833-937-2912 to learn more.

Yes! PCA’s are W-2 employees of the consumer (i.e. the patient) and pay taxes on all wages they earn. No earnings, other than Federal, State, County, City or other government mandated taxes, are deducted from a PCA’s wage. We know that quality care strongly correlates with compensation. When we pay PCA’s a respectable wage, they provide better care to their patient, thus benefiting the patient, their family, the community, the State of Missouri and the PCA. Emerest believes the CDS program plays a vital role in the health and happiness of many Missourians and is grateful to enable families and friends to care for each other with respect and dignity.

How do caregivers record their visits?

• Telephony
• Mobile App

Caregivers and Consumers can choose to use either (or both) systems. Emerest provides comprehensive training to make it easy for caregivers and consumers to understand and use these systems. With Emerest you’ll never have to fill out a paper timesheet again! So no more trips to the office or money wasted on stamps. With our systems you can record your visit and get paid without any hassle or extra expense.

At Emerest we perform a comprehensive evaluation of each participant to ensure that their personal care needs are met. At times this may entail requesting additional hours of service. Call us at 833-937-2912 to speak with one of our specialists to see if you’d qualify for additional hours.

Switching will not impact your hours. You will maintain your current service hours when you switch to Emerest. In fact, Emerest will perform a complementary evaluation to see if you qualify for additional service hours!

Yes, all consumer taxes and payments are handled by Emerest and overseen by a certified public accountant. We work closely with the IRS, Missouri Department of Revenue and local tax authorities to ensure that all taxes are properly filed and paid.

Yes, Emerest sends eligible consumers seasonal gifts and welcome packages!

Similar to CDS but geared towards individuals with Alzheimer’s and/or Dementia, this program provides a daily stipend of $53.68 to caregivers who are caring for their loved ones at home. Patients must be over the age of 21 and live in the home together with their caregiver. For more information about this program, please contact us at 833-937-2912.

Medicaid is a state and federally funded insurance program that exists in every state in the US. However, it differs greatly from state to state, and the Missouri Medicaid program is also called MO HealthNet. The Department of Social Services (DSS) has a Family Support Division (FSD) which determines eligibility for families and individuals, while MO HealthNet handles the payments and finances. The MO HealthNet program includes two different types of coverage: a fee for service program and a managed care plan. Read further to determine which program you might be eligible for. Demographically, 64% of Medicaid recipients are 18 years of age of younger, and 22% of MO HealthNet recipients are disabled or blind. 29% of Missouri adults have been diagnosed with some kind of disability, and there are over 78,000 elderly people over the age of 65 who are currently covered by MO HealthNet. The FSD does have 144 locations across the state to assist program members in any county. Medicaid in Missouri covers low-income children and their parents, guardians, or caretakers. It also covers elderly, blind, or disabled individuals who meet income and resource restriction standards. The services covered by Medicaid in Missouri include, but are not limited to:

• Outpatient/inpatient services.
• Primary, acute, and preventative care.
• Non-emergent medical transportation.
• Health screenings and immunizations.
• Necessary medical equipment.
• Family planning services.
• Behavioral health and substance abuse services.
• X-ray and laboratory services when prescribed by a physician.
• Nurse-midwife services.
• Physical, occupational, and speech therapy.

Some services are only available for certain individuals, and these additional services include:

• Dental, hearing, and vision care.
• Pharmacy and mental health services.
• In-home care.
• Rehabilitation care.
• Screening and treatment of children under 21 years of age.

There are certain criteria, specific to Missouri, that are required to qualify for the MO HealthNet program. All Missouri Medicaid applicants must:

• Reside in Missouri.
• Be a US citizen or an eligible qualified non-citizen.
• Apply for or have a valid social security number.
• Meet the individual program’s income requirements.

The Managed Care Plan: This plan falls under the MO HealthNet for Families, and covers children 18 or younger, along with their parents, caretakers, or the guardian with which they reside. Single parents must cooperate with Missouri’s Child Support Enforcement (CSE) to gain medical support from the parent who no longer has custody. Pregnant women and newborns can qualify for Medicaid while the woman is still pregnant. If pursued, this coverage includes 60 days of postpartum care and the coverage for the child extends until the first birthday of the child no matter what.

The Fee-For-Service Plan: This program is designated for seniors on Medicaid. To qualify, seniors must:

• Be at least 65 years of age.
• Intend to continue living in Missouri.
• Not be a resident of any kind of institution, with the exception of public medical institutions.

To qualify for MO HealthNet for People with Disabilities, an individual must be permanently and totally disabled in accordance with the qualifications defined by the Social Security Administration; they must be unable to gain and sustain employment for a year or longer due to a disability, either physical or mental. They must also not be a member of a public institution The income criteria for MO HealthNet programs is determined by poverty guidelines that the federal government is responsible for setting. Resources criteria can also be set, which includes assets such as savings and other countable assets; however, these resources typically only apply to the elderly, disabled, and blind applicants.

• Adult Day Care – This waiver program offers continuous care and supervision in a licensed adult day care setting for disabled adults between the ages of 18 and 63 who meet nursing facility level of need. Included is assistance in activities of daily living, planned group activities, food services, observation, and transportation.
• Independent Living Waiver (ILW)* – The independent living waiver is similar to CDS as it requires the same eligibility criteria to be met and offers daily activities assistance beyond the state plan. These additional services are case management, environmental accessibility adaptations, specialized medical supplies and equipment, and financial management services. *Emerest provides this service.
• Authorized Nurse Visits – Nurse visits are covered under the Personal Care Program, and reimbursements for these visits are offered to members demonstrating special need for these services. Nurses can monitor long term conditions, set up and administer medications such as insulin, and conduct health evaluations among other benefits. An RN (Registered Nurse) or LPN (Licensed Practical Nurse) can also be available to provide additional services such as diabetic nail care or wound management, depending on the Medicaid patient’s demonstrated need for care.
• Respite Care* – These services are offered under the Personal Care Program; they include maintenance services to participants with stable, chronic conditions who need assistance with activities of daily living (ADL). The maintenance services include time for caregivers and patients to engage in downtime activities, such as watching TV, playing board games or other forms of rest and relaxation. *Emerest provides this service.
• Structured Family Caregiver Waiver (SFCW)* – Similar to CDS, but geared towards individuals with Alzheimer’s and/or Dementia, this program provides a daily stipend of $53.68 to family caregivers who are caring for their loved ones at home. Patients must be over the age of 21 and live in the home together with their caregiver. *Emerest provides this service.
• Non-Emergency Medical Transportation (NEMT) Services – Members of the Fee-for-Service and Managed Care health plans can receive non-emergency transport provided by the state. This program is available to transport participants to and from medical appointments, therapy, hospital discharges, and other health trips. Trips must be scheduled at least 3 days in advance, but same day transport can be provided to Urgent Care facilities with 3 hours or prior notification. There is a fee of $2 per trip, which may be one-way, round trip, or have multiple stops.
• Delivered Meals – Organizations deliver fresh, frozen, or shelf stable meals to eligible individuals, and includes meal options for those with dietary restrictions including gluten-intolerant, diabetic, vegetarian, cancer meals, or pureed food choices. This program also offers nutrition counseling and a list of different food providers so that participants are able to make an informed decision about their food provider.
• Pharmacy Services – MOHealthNet utilizes a “Preferred Drug List” to expedite filling of certain prescriptions for Medicaid participants, while other medications not on the list require a special request from a physician. Aside from a dispensing fee, the state covers drugs costs for participants.

Interested in signing up for some of these additional services? Contact Emerest today at 833-937-2912 to get started.

The income requirements vary by program. Income counted for review includes employment wages, social security payments, pension and alimony payments, stock dividends, and IRA withdrawals. To qualify for the plan for Seniors and People with Disabilities, the requirements are:

• Assets valued at less than $2000 is single, and less than $4000 if married and reside with their spouse
• Net household income of less than $834 if single or $1129 if married
• Income less than $16,612 for a 1 person household, less than $5,878 per person for households 8 or larger

Assets are reviewed 5 years prior to the application date, to ensure there are no transfers of assets to date. If an individual’s assets exceed the maximum allowable amount, then those will need to be spent before a person can begin coverage.

If your monthly income exceeds the above mentioned amounts, you may become eligible when your incurred medical expenses reduce your monthly income below this limit (i.e. when you meet your spenddown).

Medicaid is free for most programs. The only reason a member would need to pay for the Seniors and Disabled plan would be if a person didn’t meet the minimum income requirements, but still qualified for a spenddown. A spenddown is an expenditure limit on medical services. Once reached, Medicaid coverage will begin for the person with the spenddown and their further services will be covered by Medicaid for that month. Spending down can include:

• A monthly submission of medical expenses to a caseworker.
• Monthly payments of the spend down amount to the MO HealthNet Division (these payments would act similarly to paying an insurance premium).

Typically, applications take 30-45 days to process, but the wait could be as long as 90+ days depending on other factors. By ensuring your application contains complete and accurate information, you can ensure the quickest possible turn-around time. If you are applying for Medicaid and you need your assets to be reviewed and appraised, this process can take extra time and might delay the processing speed of the application.

Waivers offered by Medicaid provide long-term care for those who are elderly or disabled, and allow them to live in the community to receive care rather than in a nursing facility or institution. The state prefers this process because institutionalized care is often far more expensive than home care. There are three main Home and Community Based Services (HCBS) waivers offered by the state:

• The Aged and Disabled Waiver (ADW) provides in home services to seniors requiring a nursing home level of care. This program includes respite care, chore services, adult day care, home meals delivered, and homemaker services. This program does have limited spots available at any given time.
• The Supplemental Nursing Care (SNC) provides financial assistance to those living in residential care facilities including assisted living.
• The Independent Living Waiver (ILW) is commonly used for physically disabled adults enrolling under the age of 64 to be able to continue to receive services. Some available benefits include personal care assistance, home modifications, and medical equipment and supplies. This waiver is popular with CDS program members because it allows for additional service hours of self-directed care by a person of the applicant’s own choosing. This includes family members excluding spouses, or a friend.

Applications take several weeks to process, and it is not uncommon for the state to require additional information or documentation after they have received your application. If this is the case, they will contact you by phone, mail, or email, depending on how you submitted your application, to inquire about the additional information. If you are curious about the status of your application, you can contact MO HealthNet online, or by phone at 888-275-5908

Residents of Missouri can sign up for Medicaid online, by phone, by mail, or in person at a Medicaid office. It is important that an applicant checks they qualify and have the required documents before applying. The required documents, along with an application form, include:

• Proof of US citizenship.
• Proof of Missouri residency.
• Income statements.
• Social security number.
• Current address.
• Phone number.
• Household size by person.

If an individual is applying for other family members, they must submit this information for every family member for which they are applying. This includes a separate Medicaid application for each family member. When filling out applications, it is important to be thorough and fill out all important information and dates correctly and accurately. Mistakes in this process could result in later delays in processing, or denial of admittance into the Medicaid program. If you choose to apply in person or over the phone, a representative can help walk you through the process which may be helpful to some applicants. In Medicaid FSD offices, there are forms available in English, as well as Spanish, Vietnamese, and Bosnian. If your native language is not included in these, an office representative will be available to assist you.