Missouri Agency Model Personal Care, a Medicaid home-care service for adults, can't use the participant's spouse, parent, child, sibling, grandparent or grandchild as the paid aide., In Missouri Agency Model Personal Care, an enrolled home care agency employs an aide to help with bathing, dressing, meals and other daily tasks at home., A Missouri adult child who wants to be paid can look instead to Consumer Directed Services.

In This Guide

Who Can Be the Paid Aide in Missouri Agency Model Personal Care?

Under the agency model, a home care agency "provides and employs the caregivers and handles the administrative functions," according to the Missouri Department of Health and Senior Services (DHSS). Missouri's personal care rule, 13 CSR 70-91.010, says the in-home personal care worker "may not be a family member of the participant," and it defines that family list.

Your relationship to the participant Can the agency employ you as the aide?
Spouse No
Adult child or step-child No
Parent, sibling, grandparent or grandchild No
Great grandchild Yes, if the agency approves
Niece, nephew, aunt, uncle, cousin or in-law Not on the barred list; ask the agency
Relative who lives in the same home Only if not on the barred list
Legal guardian or power of attorney agent Not stated in the sources we cite; ask DSDS

Missouri DHSS says nothing in the personal care regulation stops an agency-model aide from living in the participant's household, "However, the aide must meet the requirement of an in-home personal care worker."

If the agency can't employ you, two other Missouri programs can pay family:

Missouri's Aged and Disabled Waiver bars the same immediate family members from its homemaker, chore and respite services. If you're the spouse, getting paid to care for your spouse in Missouri covers every option.

Who Qualifies for Agency Model Personal Care

Missouri DHSS's Home and Community Based Services (HCBS) Manual 3.05 says a Missouri Agency Model Personal Care participant must be:

  • At least 18 years old.
  • In active Medicaid status, with an appropriate Medicaid Eligibility (ME) code.
  • At nursing facility level of care.

On a Medicaid spenddown, Missouri Agency Model Personal Care can be authorized during the periods your loved one meets the spenddown. For any period the spenddown isn't met, the participant is responsible for the cost of the agency-model services received. That can leave your parent with the aide's bill, so ask DSDS how spenddown periods are counted before care starts. Missouri's Division of Senior and Disability Services (DSDS) checks level of care with a face-to-face assessment, and a score of 18 or higher qualifies for Missouri's home and community based services.

A Missouri agency-model aide can help with meal preparation and eating, dressing and grooming, bathing, going to the bathroom, transfers when the participant can at least partly bear their own weight, taking their own medications, and medically related household tasks.

How Pay Works in Missouri Agency Model Personal Care

In Missouri Agency Model Personal Care, the agency is the aide's employer and runs the administrative side. DHSS's Medicaid rate table (revised July 2026) lists a unit rate of $8.14 per 15-minute unit for basic agency model personal care, with a limit of 412 units a month. If you're weighing an agency job, the $8.14 Missouri Medicaid unit rate in DHSS's July 2026 rate table isn't your paycheck: it covers 15 minutes of service, and the rate table lists no aide wage. Ask each Missouri agency what hourly wage it pays aides.

Typical pay: about $15.90 an hour (estimate based on home care aide wages in Missouri, U.S. Bureau of Labor Statistics, May 2025). The $15.90 figure, from May 2025 BLS data, is a wage estimate for home care aides in Missouri, not a rate any program pays a family caregiver.

Missouri Agency Model Personal Care is authorized in 15-minute units, in a care plan DSDS builds after assessing the participant's unmet needs., In Missouri, agency-model personal care can't exceed 60% of the participant's cost maximum, though the cost of advanced personal care and nurse visits can take the total up to 100%., For tax questions, see whether you'll get a W-2 or a 1099.

How to Start Agency Model Personal Care in Missouri

1
Step 1

Make sure your loved one has MO HealthNet

Apply for Missouri Medicaid if they don't; how to apply for Missouri Medicaid walks through it.

2
Step 2

Call DSDS at 866-835-3505

and ask about in-home personal care. Family can refer by phone or through DSDS's online form.

3
Step 3

Complete the assessment

Missouri's DSDS assesses nursing facility level of care and authorizes in-home services in a care plan.,

4
Step 4

Services start

A Missouri agency-model provider must begin services within 10 days of receiving the care plan and accepting the participant.

5
Step 5

Ask before you apply for the job

If you're a relative outside Missouri's barred family list, ask the agency whether it will hire you as the Agency Model Personal Care aide.

DHSS's home and community based services page describes Missouri Agency Model Personal Care alongside CDS and the waivers.

Frequently Asked Questions

Can my mom have an agency aide and a CDS attendant at the same time?

Missouri Agency Model Personal Care and Missouri Consumer Directed Services can be combined, but together they can't exceed 60% of the participant's cost maximum.

My dad has dementia and I live with him. Which program fits?

Missouri Agency Model Personal Care can't employ you as his aide, because an adult child is on the barred family list. Missouri's Structured Family Caregiving Waiver is built for your situation: it serves Missourians 21 and over with Alzheimer's disease or a related dementia, the paid primary caregiver must be the live-in caregiver already providing care, and it pays by the day rather than by the hour.

Learn More

CaregiverHow to Get Paid as a Family Caregiver in MissouriGet paid as a family caregiver in Missouri in 2026: Consumer Directed Services, the dementia caregiving waiver that can pay a spouse, pay rates, and VA options. CaregiverHow to Get Paid to Care for Your Spouse in MissouriIn Missouri a spouse cannot be paid through Medicaid CDS, but the Structured Family Caregiving Waiver (dementia) and the VA's PCAFC stipend can pay a spouse. CaregiverMissouri Caregiver ProgramsEvery caregiver program in Missouri: Consumer Directed Services paid pathways, the Aged and Disabled Waiver, respite, NFCSP grants, VA benefits, and taxes. CaregiverMissouri Consumer Directed Services Family Caregiver PayMissouri Consumer Directed Services family caregiver pay: an adult child or other relative can be the paid CDS attendant; a spouse can't. Pay and steps. MedicaidMissouri Medicaid HCBS WaiversMissouri Medicaid HCBS waivers pay for home and community care through MO HealthNet's Aged and Disabled Waiver for adults who need nursing-facility care. Care TypesHome Care vs. Home Health in MissouriHome care vs. home health in Missouri: home health is skilled care Medicare covers, home care is non-medical help it won't, and DHSS licenses each differently.

Get help sorting out paid care for a parent in Missouri at brevy.com.

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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Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.