Missouri pays many family members to provide care through Consumer Directed Services, though not spouses. Add the Aged and Disabled Waiver, respite grants, and VA benefits.
If you are caring for an aging parent, a spouse, or an adult child with a disability in Missouri, the hard part is rarely whether help exists. It is knowing what is there and where to start. This guide maps every major caregiver program in the state for 2026.
You don't have to figure this out alone, and you don't have to fund all of it from your savings.
In This Guide
- Missouri Caregiver Programs at a Glance
- Programs That Pay Family Caregivers
- Respite Care Programs
- Support, Training, and Area Agencies
- VA Caregiver Benefits in Missouri
- Taxes for Missouri Caregivers
- Frequently Asked Questions
- Learn More
Missouri Caregiver Programs at a Glance
| Program | What It Offers | Who Qualifies | Cost to You |
|---|---|---|---|
| Consumer Directed Services (CDS) | Adult hires and directs their own attendant (not spouse or guardian) | Medicaid adults 18+ with physical disability, NF level of care, self-directing | Free (paid by Medicaid) |
| Aged and Disabled Waiver (ADW) | In-home services including respite | Older adults at nursing-facility level of care | Free (paid by Medicaid) |
| NFCSP respite grants | Free in-home respite, adult day vouchers, training, counseling | Caregivers of adults 60+ or person with ADRD; no income test | Free |
| VA PCAFC | Monthly tax-free stipend; pays spouses | Veteran with 70%+ disability in VA health care | Free (VA benefit) |
| VA Aid and Attendance | Pension up to $2,424/mo to veteran; caregiver paid from it | Wartime veteran or surviving spouse under net-worth limit | Free to apply (VSO help) |
Programs That Pay Family Caregivers
Consumer Directed Services (CDS)
Missouri's Consumer Directed Services (CDS) program is a MO HealthNet (Medicaid) State Plan personal care benefit administered through the Department of Health and Senior Services (DHSS), Division of Senior and Disability Services. It lets a Medicaid-eligible adult (18 or older) with a physical disability who can self-direct their own care, and who meets a nursing facility level of care, hire, train, schedule, and manage their own personal care attendant. The consumer is the employer; DSDS determines functional eligibility and the Family Support Division determines financial eligibility.
Who can be the paid attendant: An adult child, sibling, other family member, friend, or neighbor. Who cannot: the consumer's spouse or legal guardian, per Missouri regulation 19 CSR 15-8.100, which defines a CDS attendant as "a person, other than the consumer's spouse."
The consumer selects a CDS vendor, which holds a written agreement with DHSS and acts as the fiscal intermediary, handling payroll, tax withholding, and employer paperwork while the consumer directs the work.
Aged and Disabled Waiver (ADW)
Missouri's Aged and Disabled Waiver (ADW) is a 1915(c) Medicaid HCBS waiver also administered by DHSS, Division of Senior and Disability Services. It serves older adults who meet a nursing-facility level of care and provides in-home services, including respite, that complement or substitute for CDS depending on the person's needs.
For the full guide to paid pathways: How to Get Paid as a Family Caregiver in Missouri.
Respite Care Programs
Medicaid Respite (ADW and CDS)
Respite can be authorized within the Aged and Disabled Waiver care plan or arranged through the CDS service plan. Ask your DSDS case manager or CDS vendor about adding respite.
NFCSP Grants Through Missouri's 10 Area Agencies on Aging
The National Family Caregiver Support Program (NFCSP), funded by Title III-E of the Older Americans Act, flows through the Missouri DHSS Division of Senior and Disability Services to 10 regional Area Agencies on Aging. Services include in-home respite, adult day vouchers, caregiver training, and counseling, with no income test for respite services. Call 1-800-392-0210.
For the full respite guide: Respite Care in Missouri.
Support, Training, and Area Agencies
Missouri's 10 Area Agencies on Aging are the front door for most caregiver support that is not tied to a Medicaid waiver. They deliver NFCSP services, adult day referrals, caregiver training, counseling, and local resource information.
Call 1-800-392-0210 to reach your regional AAA, or dial 211 for the broader social-services network. These calls are free. A counselor will identify what is available in your county and help you start an application.
If your loved one is enrolled in CDS or the ADW, the DSDS case manager (or your chosen CDS vendor) is your key contact for adjusting the service plan, including adding respite.
VA Caregiver Benefits in Missouri
Veterans enrolled in VA health care in Missouri have access to caregiver support programs that are separate from Medicaid and often more generous.
VA Program of Comprehensive Assistance for Family Caregivers (PCAFC)
The PCAFC pays a monthly stipend to the Primary Family Caregiver of an eligible veteran. The stipend is calculated from the federal GS-4, Step 1 annual rate for the veteran's locality, divided by 12, then multiplied by a level factor. It is federal tax-free and allows paid spouses. To qualify, the veteran needs a service-connected disability rating of 70 percent or higher, a need for in-person personal care for at least six continuous months, and enrollment in VA health care.
Because the CDS program excludes spouses, the PCAFC stipend and Veteran-Directed Care are often the only routes through which a Missouri spouse can be paid to provide care.
Missouri VA facilities: The St. Louis VA Health Care System, the Kansas City VA Medical Center, the Harry S. Truman Memorial Veterans' Hospital in Columbia, and the John J. Pershing VA Medical Center in Poplar Bluff are the main VA medical centers.
VA Aid and Attendance Pension
Wartime veterans and surviving spouses who meet the functional criteria and have countable assets and income under the net-worth limit ($163,699 in 2026) may receive the Aid and Attendance pension. A single veteran with Aid and Attendance receives up to $2,424 per month ($29,093/year); a veteran with one dependent up to $2,874 per month. The pension goes to the veteran, who typically pays a family caregiver from it.
The Missouri Veterans Commission and county Veterans Service Officers help file at no cost.
VA Caregiver Support Line: 1-855-260-3274
Taxes for Missouri Caregivers
IRS Notice 2014-7
If you live in the same home as the person you care for and are paid through a Medicaid program, your wages may be excluded from federal gross income under IRS Notice 2014-7. This applies to many Missouri CDS arrangements. Talk to a tax preparer familiar with the rule before filing.
Missouri State Income Tax
Missouri levies a graduated individual income tax. Because Missouri starts from federal adjusted gross income, the IRS Notice 2014-7 exclusion generally flows through to the Missouri return. Confirm the current rates with the Missouri Department of Revenue.
VA PCAFC Stipend
The PCAFC monthly stipend is federal tax-free and is not reported on a W-2.
Not sure which Missouri caregiver program fits your family? Chat with Brevy's care navigator for a personalized comparison based on your loved one's MO HealthNet enrollment, veteran status, and whether you are a spouse or non-spouse caregiver.
Frequently Asked Questions
Not through Consumer Directed Services. Missouri regulation 19 CSR 15-8.100 excludes a spouse (and a legal guardian) from being the paid CDS attendant. If your spouse is a veteran enrolled in VA care, the PCAFC stipend and Veteran-Directed Care can pay a spouse.
An adult child, sibling, other family member, friend, or neighbor (anyone other than the consumer's spouse or legal guardian) may be hired and paid as the CDS personal care attendant. The consumer is the employer and directs the work.
A CDS vendor is a person, firm, or corporation that holds a written agreement with DHSS and acts as the fiscal intermediary for the program, handling payroll, tax withholding, and employer paperwork while the consumer directs the attendant's work.
Yes. The National Family Caregiver Support Program provides free respite through Missouri's 10 Area Agencies on Aging with no income test. Call 1-800-392-0210.
Call 1-800-392-0210 to reach your regional AAA, or dial 211. Missouri has 10 AAAs serving every county; they handle NFCSP respite grants, adult day referrals, and caregiver training.
Learn More
- How to Get Paid as a Family Caregiver in Missouri
- Respite Care in Missouri
- Caregiver Burnout: Signs, Stages, and How to Get Support
- VA Aid and Attendance in Missouri
- Medicaid Planning Strategies
Find personalized help navigating Missouri caregiver programs 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.