Missouri families can be paid to care for a parent at home through Consumer Directed Services, which pays an adult child or other relative, not a spouse, as a personal care attendant. In this MO HealthNet (Medicaid) program, known as CDS, an adult with a physical disability hires and directs their own attendant for hands-on help with daily tasks. Missouri Consumer Directed Services family caregiver pay starts with a call to the state's Division of Senior and Disability Services (DSDS) at 866-835-3505.

In This Guide

Who Can Get Family Caregiver Pay Through Missouri Consumer Directed Services?

Under CDS, the person receiving care is your employer of record, hiring, training, supervising and directing their own attendant.

The Missouri Department of Health and Senior Services (DHSS) Home and Community-Based Services (HCBS) Manual says it plainly: "The attendant may be a family member. However, the attendant cannot be the participant's spouse or legal guardian." Section 208.900 RSMo backs the spouse bar, defining a personal care attendant as a person "other than the consumer's spouse."

Your relationship Can you be paid as the CDS attendant?
Adult child, sibling, grandchild or other relative Yes
Spouse, including a same-sex spouse No
Court-appointed guardian or conservator No
Relative who lives in the same home Yes; shared chores aren't paid
Representative payee Not prohibited; the vendor may add limits
Agent under a power of attorney Not stated in the sources we cite; ask DSDS

Attendants also face age, fitness and background-check rules, listed in our Missouri programs guide.

If you're the spouse, Missouri's Structured Family Caregiving Waiver can pay a live-in spouse or legal guardian caring for someone with Alzheimer's or a related dementia. Getting paid to care for your spouse in Missouri covers every option.

Does Your Loved One Qualify for CDS?

Missouri's HCBS Manual 3.25 requires a CDS participant to be:

  • At least 18 years old.
  • Physically disabled, as CDS defines it.
  • Able to self-direct their care and live independently.
  • At nursing facility level of care.
  • In active Medicaid status, with an appropriate Medicaid Eligibility (ME) code.
  • Free of any previous involvement in Medicaid fraud.

Someone living in a nursing facility, or in a DHSS-licensed residential care or assisted living facility, isn't eligible. A participant on a spenddown can receive CDS only in months they meet it; in other months the participant and vendor may make a private arrangement, at the participant's cost. Guardianship has its own CDS rules; see our Missouri programs guide.

What CDS Pays For, and What It Doesn't

CDS provides "hands-on" assistance with physical tasks based on the participant's physical limitations. No time can be authorized for stand-by assistance, prompting or cueing, for respite, or for time spent waiting at appointments. If you mostly supervise a parent with memory loss, the dementia waiver above may fit better.

If you live together, CDS won't pay for tasks household members would reasonably share; the full household rule has one exception.

DSDS's assessment sets the hours, authorized in 15-minute units. CDS can't exceed 60% of the participant's cost maximum, including when combined with agency-model personal care. Missouri's rate table also caps CDS at 641 units a month.

What Missouri Consumer Directed Services Family Caregiver Pay Looks Like

Typical pay: about $15.90 an hour (estimate based on home care aide wages in Missouri, May 2025). That U.S. Bureau of Labor Statistics median is an occupational wage estimate, not a rate any program pays a family caregiver.

DHSS's rate table (revised July 2026) lists $5.23 per 15-minute unit for consumer-directed personal care, which Missouri Medicaid pays the CDS vendor on the participant's behalf, not you; the vendor runs your payroll. The participant verifies the wages paid to the attendant, and the general assembly sets the statewide CDS rate.

DHSS's CDS manual and rate table state no attendant wage. If you're weighing cutting back at work, ask each vendor what it pays before your loved one chooses one.

Under 19 CSR 15-8.400 the vendor collects and verifies Electronic Visit Verification (EVV) records, sends your pay on the participant's behalf, and ensures "all payroll, employment, and other taxes are paid timely." It also trains the participant and checks in monthly, with a yearly face-to-face visit. You're the participant's employee, never the vendor's or the state's.

How to Get Hired as a CDS Attendant

1
Step 1

Make sure your loved one has MO HealthNet

The Family Support Division decides financial eligibility; income and asset limits are in how to apply for Missouri Medicaid.

2
Step 2

Call DSDS at 866-835-3505

and ask for Consumer Directed Services. Family members can refer by phone or DSDS's online form.

3
Step 3

Complete the assessment

DSDS decides functional eligibility, including nursing facility level of care, and authorizes the units.

4
Step 4

Choose a CDS vendor

Your loved one picks a provider enrolled for CDS with Missouri Medicaid Audit and Compliance (MMAC).

5
Step 5

Get hired and start logging visits

Your loved one hires you; the vendor runs your background checks and verifies your EVV records for payroll.,

Is CDS Pay Taxable?

Don't assume CDS pay is tax-free. IRS Notice 2014-7 covers Medicaid 1915(c) waiver payments for care in a home the caregiver shares, while Missouri calls CDS a State Plan benefit, where the IRS says treatment depends on the program, so ask a tax professional. See whether Medicaid caregiver payments are taxable and whether you'll get a W-2 or a 1099.

Frequently Asked Questions

I have my mom's power of attorney. Can I still be her paid CDS attendant?

The CDS sources we cite don't say whether a power of attorney agent can be the paid attendant. Under 19 CSR 15-8.100, a power of attorney covering the CDS duties can keep your mom from counting as a CDS consumer, so ask DSDS at 866-835-3505 before you count on the income.,,

Can the vendor stop my parent's CDS services?

Yes. After notice to DHSS, a vendor may suspend services in listed situations, including when the participant can no longer self-direct.

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. 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. MedicaidHow to Apply for Missouri MedicaidApply for Missouri Medicaid (MO HealthNet) online, by phone at 855-373-9994, or on form IM-1SSL by mail, fax or in person, plus the $6,220.50 asset limit.

Find personalized help getting hired as a CDS attendant 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.