An Easy Understanding of Consumer-Directed Services (CDS)

**Please note: In order to get started with the CDS program you must use a Fiscal Intermediary. FreedomCare is the #1 Fiscal Intermediary in the MO area. To see if you are eligible to get started with FreedomCare click here.

Are you among the 29 percent of Missouri adults diagnosed with some form of disability? Or perhaps you have an elderly family member who has reached a point where he or she needs assistance with daily activities like shopping, personal hygiene, cooking, household chores, and more.

As a Missouri resident, you or your family member might be eligible to take advantage of Consumer Directed Services (CDS), a program through Missouri State Medicaid designed to help adults with physical disabilities take control of their own home care needs.

In this article, we’ll look at what CDS is, how it works, and how it can benefit a Missouri resident living with disabilities. We will also address some of the most common questions about CDS from the perspective of someone looking to provide care services.


What is Consumer Directed Services (CDS)?

Consumer Directed Services (CDS) is a program through Missouri State’s Medicaid designed to assist people living with physical disabilities in MO. The program provides for care services from a personal care attendant (PCA), allowing the care recipient to live in their own homes and communities, instead of the more restrictive environment in an institution. The Consumer Directed Services program is administered by Missouri’s Division of Health and Senior and Services (DHSS).


What are self-directed services?

The idea behind self-directed or consumer-directed services is to let the consumer (the care recipient) be in charge of their caregiving needs. They are the ones that know best when it comes to what they need assistance with, and CDS gives them the ability to hire caregivers that suit their specific needs. And since the program is funded through Medicaid, the care recipient does not need to worry about additional medical bills (assuming, of course, they are eligible for CDS, which we’ll discuss below).


What are the benefits of Consumer Directed Services (CDS)?

The most significant benefit of the Missouri CDS program is that the care recipient gets to live in an environment in which they are comfortable, despite their disability. Like many people, you might not want to move into a nursing home, separated from your community. 

Another benefit of CDS is that you are allowed to hire friends or family members to provide you caregiving services. The only exception is that they cannot be your spouse or legal guardian. By allowing you to hire a caregiver of your choice, CDS makes it possible for you to receive care from someone you like and trust, instead of a stranger at a nursing home.

Also, when a personal care assistant helps you with daily living activities, you will be able to live on your own and pursue things that otherwise might not have been possible due to your disability. You can continue working, going to school, or pursuing your hobbies and passions.

Finally, if you’re a caregiver, CDS allows you to earn money while you provide care for a friend or family member (as long as you are not their spouse or legal guardian). The extra income could be ideal if you’re a college student looking for part-time work, or if you’re retired and on a fixed income. Caregivers typically make around $10 per hour in Missouri (Freedomcare’s pay rate is $11 per hour.)


How does Consumer Directed Services (CDS) work?

To qualify for CDS, you would have to be deemed eligible by Missouri’s Division of Health and Senior Services (DHSS). 

One of the prerequisites of CDS is that you have to be currently on MO HealthNet, which is Missouri’s Medicaid program. If you’re not presently enrolled in MO Healthnet, you can call them at 855-835-3505.

Once you enroll in MO Healthnet, you can apply through DHSS. They will schedule a pre-screening and a home assessment to determine your requirements when it comes to assistance and personal care.

The personal care assistance that you can expect through CDS will be non-medical. You will get help with tasks that you are no longer able to do yourself due to your disability, or with regular tasks that would take you an unreasonable amount of time to complete. Through CDS, you can only get help with activities of daily living (ADL), and it would not include anything that requires a licensed medical professional.

As a participant in the CDS program, you will also be required to hire, train, and direct your caregiver. The specific tasks your care assistant helps you will vary based on your needs, and according to your disability and living arrangements. However, here are some of the typical things that you can expect your assistant to help you with:

  • Grooming
  • Bathing
  • Personal hygiene
  • Toilet use
  • Mobility
  • Taking medications on time
  • Cleaning
  • Laundry
  • Cooking
  • Shopping
  • Essential transportation 

For the care services, your personal care assistant (PCA) will get compensated at an hourly basis through Consumer Directed Services (CDS) and Medicaid (typically around $10 per hour). As mentioned above, you can hire your friends or family members as caregivers, except for your spouse or legal guardian.


Am I eligible for the Consumer Directed Services (CDS) Program? 

Let’s look at some of the requirements and conditions when it comes to being eligible to participate in CDS.


Health needs requirements

CDS is meant for people who cannot perform daily activities due to physical disabilities or illness. Unfortunately, it does not currently provide care for people with mental conditions like dementia.

Here are the requirements to be eligible for CDS:

  • Be a Missouri resident above the age of 18 years.
  • Have a physical disability that makes you unable to perform daily activities like meal preparation, bathing, cleaning, etc.
  • Require the level of care that might be provided at a nursing home.
  • Be able to direct your caregiver and train them according to your needs.

You do not have to be a senior to qualify for CDS, although many program participants happen to fall in the elderly category.


MO HealthNet requirements

MO HealthNet is Missouri’s Medicaid program that covers qualified medical costs for people that meet specific eligibility requirements. To be eligible for CDS, you must be currently enrolled in MO HealthNet. 

Your MO HealthNet eligibility will be dependant on your age, income, and assets. Let’s take a look at these requirements:

  • Have a net household income of less than $885 per month if single or widowed.
  • Have a net household income of less than $1,198 per month if married.
  • Own assets worth less than $2,000 if single.
  • Own assets worth less than $4,000 if married.

The monthly income numbers are equal to 85 percent of the Federal Poverty Level guidelines. So, they might change periodically. 

Some assets don't count towards the eligibility requirement numbers. This includes your home if you live there, and the equity value is not more than $585,000. Personal items and your car are also exempt from being counted as assets. 


Eligibility via the spend-down deductible

If you earn more than the income limit to be eligible for CDS, there might still be a way for you to qualify through a spend-down, which is similar to a deductible. 

The income you earn above the eligibility level, you would spend it on medical and care expenses. Once you’ve used enough of your income to reach the limit for CDS, you would be able to qualify for the remainder of your care expenses.


What if I have an elderly parent who is unwilling to accept home care?

Like many seniors, your elderly parents might be reluctant when it comes to accepting home care services through CDS. They might feel like a caregiver could infringe upon their independence, or that receiving home care is a sign of weakness. Seniors may often have privacy concerns about letting someone come into their homes as well.

While you should be respectful of their concerns, you know that having access to home care will enhance their quality of life. If your loved one has a disability, a caregiver will make sure they are safe and comfortable, and it would actually make them more independent as they can continue living within their community. 

With that in mind, your job is to present the idea to your parents in a way that addresses their concerns, but also communicates home care as a benefit to them, and maybe even you.

Bring up home care as something that would give you peace of mind. Knowing that your loved one is safe and taken care of will allow you to better focus on your day. You could also present the idea as a way to help a friend or relative that could use the extra income. They make some money, and your parent gets to use the free time to pursue their interests.


What to look for in a personal care assistant (PCA)?

Choosing the right personal care assistant (PCA) for yourself or a loved one can be a challenging task. Through CDS, you can hire someone you already know and like, such as a friend or family member. However, it still makes sense to think it through and pick someone who will be a good fit for the job.

Here are a few things you should keep in mind when hiring a PCA:

  • Understanding your needs - Make sure the care assistant has a solid understanding of all the tasks they would be helping you with. Also, make sure they are adequately capable of helping with those duties.
  • Relevant experience - If possible, try to find a care service provider who has some relevant experience. Maybe with their own family members. They will be more likely to understand your needs and provide care accordingly.
  • The job fits their life - For the relationship to be successful, the caregiving arrangement has to work for all parties involved. That means the workload and compensation must fit in with the caregiver’s own life, like their work schedule and living expenses.


How to apply for Consumer Directed Services (CDS)?

For more information on CDS and to learn about how you can apply, contact Freedomcare and a representative will answer all your questions. You can reach us at 816-281-1359.

You can also learn more about CDS on the Division of Health and Senior Services (DHSS) website.


Frequently asked questions about Consumer Directed Services (CDS)

Q: Can a family member get paid to be a caregiver in Missouri?

A: A family member can get paid to be a caregiver in Missouri through the CDS program. The only exception is that you cannot be the spouse or legal guardian of the care recipient. 


Q: Can a wife get paid for taking care of her husband?

A: When it comes to CDS, a spouse is not eligible to be a caregiver. So, a wife cannot get paid to take care of her husband, or vice versa.


Q: Can you get paid for taking care of an elderly parent?

A: Yes, you are eligible to get paid through CDS for taking care of an elderly parent.


Q: How much can I get paid for caring for a friend or family?

A: Most caregivers make around $10 per hour in the state of Missouri.


Q: Do I need to be a senior to receive care through CDS?

A: No, you can be eligible for CDS if you're above the age of 18, a Missouri resident, and enrolled in MO HealthNet.


Final Thoughts

Life can be challenging for people diagnosed with disabilities. Not being able to perform activities of daily living such as bathing, grooming, cooking, cleaning, etc. can have a significant impact on your quality of life. 

For many who are living with disabilities, the only options, unfortunately, involve moving to an assisted living facility or a nursing home away from their communities. If you’re a Missouri resident, you might be fortunate enough to have access to the Consumer Directed Services program that allows you to have access to care as you continue living in your home.