A Missouri Aged and Disabled Waiver family caregiver who is immediate family can't be paid as the homemaker, chore or respite worker. Missouri's Aged and Disabled Waiver homemaker, chore and respite workers must be agency employees, and immediate family means a parent, child or step-child, sibling, spouse, grandparent or grandchild.dss.mo.gov. (1915). Application for 1915(c) HCBS Waiver: MO.0026.R09.00 (Aged and Disabled Waiver), approved effective 07/01/23 - as posted by the Missouri Department of Social Services, MO HealthNet Division ('Waiver Documents', Aged and Disabled Waiver page). Retrieved Oct 14, 2026, from https://dss.mo.gov/sites/mydss/files/media/pdf/2023/12/aged-and-disabled-waiver.pdf For an older parent or spouse, the Missouri Aged and Disabled Waiver is a Medicaid program that pays for homemaker, chore and respite help, meals and adult day care.Centers for Medicare & Medicaid Services. (n.d.). Missouri Waiver Factsheet. medicaid.gov. Retrieved Sep 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/MO The Missouri Aged and Disabled Waiver's one opening for immediate family is adult day care: a relative who meets every provider qualification may work at the person's licensed Missouri adult day program.dss.mo.gov. (1915). Application for 1915(c) HCBS Waiver: MO.0026.R09.00 (Aged and Disabled Waiver), approved effective 07/01/23 - as posted by the Missouri Department of Social Services, MO HealthNet Division ('Waiver Documents', Aged and Disabled Waiver page). Retrieved Oct 14, 2026, from https://dss.mo.gov/sites/mydss/files/media/pdf/2023/12/aged-and-disabled-waiver.pdf To ask about the waiver or a Missouri program that can pay you, call the Division of Senior and Disability Services (DSDS) at 866-835-3505.Missouri Department of Health and Senior Services. (n.d.). HCBS Referrals, Requests & Eligibility Determination - Missouri DHSS. health.mo.gov. Retrieved Sep 4, 2026, from https://health.mo.gov/partners-providers/home-community-based-services-provider-information/hcbs-referrals-requests-eligibility-determination
In This Guide
- Can a Family Caregiver Be Paid Under the Missouri Aged and Disabled Waiver?
- What the Waiver Pays For When Family Lives There
- Does Your Loved One Qualify?
- Missouri Programs That Can Pay You Instead
- How a Family Caregiver Can Start the Missouri Aged and Disabled Waiver
- Frequently Asked Questions
Can a Family Caregiver Be Paid Under the Missouri Aged and Disabled Waiver?
You may hope your parent's approved help could come from you. For in-home work, Missouri says no. The Missouri Department of Health and Senior Services (DHSS) Home and Community-Based Services (HCBS) Manual says the Aged and Disabled Waiver homemaker and chore worker "is an employee of the HCBS provider and cannot be a member of the immediate family of the participant," and the waiver's respite aide carries the same bar.dss.mo.gov. (1915). Application for 1915(c) HCBS Waiver: MO.0026.R09.00 (Aged and Disabled Waiver), approved effective 07/01/23 - as posted by the Missouri Department of Social Services, MO HealthNet Division ('Waiver Documents', Aged and Disabled Waiver page). Retrieved Oct 14, 2026, from https://dss.mo.gov/sites/mydss/files/media/pdf/2023/12/aged-and-disabled-waiver.pdf
| Your relationship | Paid homemaker, chore or respite worker? | Paid at the adult day program? |
|---|---|---|
| Adult child, step-child, sibling, parent, grandchild or grandparent | No | Only if you meet licensure and provider rules |
| Spouse | No | Not stated; ask DSDS |
| Legal guardian | Not addressed; ask DSDS | Only if you meet licensure and provider rules |
| Agent under a power of attorney | Not addressed; ask DSDS | Not addressed; ask DSDS |
The Missouri Aged and Disabled Waiver's adult day care opening comes from the approved waiver: Missouri licensure laws "do not restrict relatives or legal guardians from the provision of adult day care services to relatives," if the program follows those laws and the person meets every provider qualification, including owners, operators and employees.dss.mo.gov. (1915). Application for 1915(c) HCBS Waiver: MO.0026.R09.00 (Aged and Disabled Waiver), approved effective 07/01/23 - as posted by the Missouri Department of Social Services, MO HealthNet Division ('Waiver Documents', Aged and Disabled Waiver page). Retrieved Oct 14, 2026, from https://dss.mo.gov/sites/mydss/files/media/pdf/2023/12/aged-and-disabled-waiver.pdf This exception doesn't pay for care at home.
What the Waiver Pays For When Family Lives There
The Missouri Aged and Disabled Waiver covers homemaker, chore, respite, home-delivered meals and adult day care, and respite comes in basic and advanced forms.Centers for Medicare & Medicaid Services. (n.d.). Missouri Waiver Factsheet. medicaid.gov. Retrieved Sep 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/MO If you live with your parent, two household rules apply:dss.mo.gov. (1915). Application for 1915(c) HCBS Waiver: MO.0026.R09.00 (Aged and Disabled Waiver), approved effective 07/01/23 - as posted by the Missouri Department of Social Services, MO HealthNet Division ('Waiver Documents', Aged and Disabled Waiver page). Retrieved Oct 14, 2026, from https://dss.mo.gov/sites/mydss/files/media/pdf/2023/12/aged-and-disabled-waiver.pdf
- Homemaker: Missouri doesn't authorize waiver homemaker services when the participant lives with others able to do the tasks. If necessary, Missouri may authorize only tasks essential for the participant, such as cleaning their room, changing their linens or cleaning the bathroom after a bath, never common areas.
- Chore: Missouri provides waiver chore services only when the household can't do the tasks and no other relative, caregiver, landlord, agency or third-party payer is capable of or responsible for them.
Respite is the service built for you. DHSS says Missouri Aged and Disabled Waiver respite relieves caregivers who may include "family, friends, or neighbors who provide unpaid support," up to 49 hours a week.dss.mo.gov. (1915). Application for 1915(c) HCBS Waiver: MO.0026.R09.00 (Aged and Disabled Waiver), approved effective 07/01/23 - as posted by the Missouri Department of Social Services, MO HealthNet Division ('Waiver Documents', Aged and Disabled Waiver page). Retrieved Oct 14, 2026, from https://dss.mo.gov/sites/mydss/files/media/pdf/2023/12/aged-and-disabled-waiver.pdf Aged and Disabled Waiver respite won't pay you, but it pays an agency aide so you get real time off. Our Missouri respite care guide covers other options.
Does Your Loved One Qualify?
These are the tests DSDS checks, and a parent who misses one on paper isn't always shut out. Missouri's two descriptions of the Aged and Disabled Waiver age rule differ: the state's myDSS page says 63 or older; the federal Centers for Medicare & Medicaid Services (CMS) factsheet says 65 or older, or 63 to 64 with a physical disability. Both descriptions of the Missouri Aged and Disabled Waiver require a nursing facility level of care, so ask DSDS which age rule applies.Centers for Medicare & Medicaid Services. (n.d.). Missouri Waiver Factsheet. medicaid.gov. Retrieved Sep 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/MO
- Care needs: DSDS assesses your parent face to face with the InterRAI tool, and a score of 18 or higher meets the level of care.Centers for Medicare & Medicaid Services. (n.d.). Missouri Waiver Factsheet. medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/MO
- Income: Missouri's Home and Community-Based (HCB) category lists a monthly limit of $1,737 for the individual, not counting a spouse, effective January 2026, that can't be met by spending down.Centers for Medicare & Medicaid Services. (n.d.). Missouri Waiver Factsheet. medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/MO,dssmanuals.mo.gov. (n.d.). Missouri DSS MHABD Manual 0820.030.15 — Income and Budgeting (Eligibility Based on Receipt of HCB Waiver Services). Retrieved Oct 3, 2026, from https://dssmanuals.mo.gov/mo-healthnet-for-the-aged-blind-and-disabled/0820-030-15 Monthly income over the 2026 limit of $1,737 isn't the end of the road: income placed in a Qualified Income Trust doesn't count, and Missouri limits trust use to nursing facility care or the Aged and Disabled Waiver.dssmanuals.mo.gov. (n.d.). Missouri DSS MHABD Manual 0820.030.15 — Income and Budgeting (Eligibility Based on Receipt of HCB Waiver Services). Retrieved Oct 3, 2026, from https://dssmanuals.mo.gov/mo-healthnet-for-the-aged-blind-and-disabled/0820-030-15
- Resources: Missouri's HCB resource maximum is $6,220.50 after Division of Assets, effective July 2026, so savings above it matter.Centers for Medicare & Medicaid Services. (n.d.). Missouri Waiver Factsheet. medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/MO
Missouri Programs That Can Pay You Instead
If a paycheck matters to your family, ask DSDS about two other routes.
- Consumer Directed Services (CDS): the person needing care hires their own attendant, who may be a family member but not a spouse or legal guardian.Missouri Department of Health and Senior Services. (n.d.). Missouri DHSS Home and Community Based Services Manual 3.25 Personal Care Assistance - State Plan (Consumer-Directed Service Model). health.mo.gov. Retrieved Oct 14, 2026, from https://health.mo.gov/providers/manuals/home-and-community-based-services-manual/300-available-home-and-community-based-4 See how CDS pays a family member.
- Structured Family Caregiving Waiver (SFCW): for someone 21 or older with Alzheimer's or a related dementia, it pays a live-in family caregiver, a spouse included, through an enrolled provider agency.dss.mo.gov. (1915). Application for 1915(c) HCBS Waiver: MO.1706.R00.04 (Structured Family Caregiving), approved effective 07/01/23 - as posted by the Missouri Department of Social Services, MO HealthNet Division ('Waiver Documents', Structured Family Caregiving Waiver page). Retrieved Oct 14, 2026, from https://dss.mo.gov/sites/mydss/files/media/pdf/2023/12/structured-family-caregiving-waiver.pdf See how SFCW pays a live-in caregiver.
Because Missouri allows one waiver at a time, moving to SFCW means leaving the Aged and Disabled Waiver.Centers for Medicare & Medicaid Services. (n.d.). Missouri Waiver Factsheet. medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/MO
How a Family Caregiver Can Start the Missouri Aged and Disabled Waiver
Call DSDS at 866-835-3505
or use its online HCBS referral form. Family members can refer by phone.Missouri Department of Health and Senior Services. (n.d.). HCBS Referrals, Requests & Eligibility Determination - Missouri DHSS. health.mo.gov. Retrieved Sep 4, 2026, from https://health.mo.gov/partners-providers/home-community-based-services-provider-information/hcbs-referrals-requests-eligibility-determination
Complete the assessment
DSDS checks level of care and unmet needs, then builds a person-centered care plan with your parent.Centers for Medicare & Medicaid Services. (n.d.). Missouri Waiver Factsheet. medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/MO
Apply for MO HealthNet
, Missouri's Medicaid program, if your parent isn't already enrolled; see how to apply for Missouri Medicaid.Centers for Medicare & Medicaid Services. (n.d.). Missouri Waiver Factsheet. medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/MO
Ask about paid-family routes in the same call
Ask DSDS whether CDS or SFCW fits your parent better.Missouri Department of Health and Senior Services. (n.d.). HCBS Referrals, Requests & Eligibility Determination - Missouri DHSS. health.mo.gov. Retrieved Sep 4, 2026, from https://health.mo.gov/partners-providers/home-community-based-services-provider-information/hcbs-referrals-requests-eligibility-determination
Frequently Asked Questions
Is there a waiting list for the Missouri Aged and Disabled Waiver?
There may be. DSDS says that because of enrollment limits, some of its six Missouri waivers might have a waiting list.Centers for Medicare & Medicaid Services. (n.d.). Missouri Waiver Factsheet. medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/MO When you call DSDS at 866-835-3505, ask whether the Aged and Disabled Waiver has one now.Missouri Department of Health and Senior Services. (n.d.). HCBS Referrals, Requests & Eligibility Determination - Missouri DHSS. health.mo.gov. Retrieved Sep 4, 2026, from https://health.mo.gov/partners-providers/home-community-based-services-provider-information/hcbs-referrals-requests-eligibility-determination
Can a legal guardian or power-of-attorney agent be paid under the Missouri Aged and Disabled Waiver?
A qualified legal guardian can be paid at the person's licensed adult day program under the Missouri Aged and Disabled Waiver. The DHSS manual sections and approved waiver Brevy reviewed don't address a guardian or power-of-attorney agent as a paid homemaker, chore or respite worker, so ask DSDS before counting on that pay.dss.mo.gov. (1915). Application for 1915(c) HCBS Waiver: MO.0026.R09.00 (Aged and Disabled Waiver), approved effective 07/01/23 - as posted by the Missouri Department of Social Services, MO HealthNet Division ('Waiver Documents', Aged and Disabled Waiver page). Retrieved Oct 14, 2026, from https://dss.mo.gov/sites/mydss/files/media/pdf/2023/12/aged-and-disabled-waiver.pdf
Learn More
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The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.
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