Consumer Directed Services in Missouri
Consumer Directed Services, usually shortened to CDS, is a MO HealthNet program that pays for personal care in your own home — with one crucial difference from ordinary home care. You choose the person who provides it.
In a traditional home care arrangement, an agency employs the aides, decides which one comes to your house, and sets the schedule. If that person is a poor fit, you get a different stranger. CDS inverts that. The state authorizes a number of hours based on your assessed need, and you hire someone you already trust to do the work.
The three parties, and what each one does
| Who | Role |
|---|---|
| You (the consumer) | The employer. You recruit, hire, train, schedule, supervise and — if necessary — discharge your attendant. You sign timesheets and verify the hours worked. |
| Your attendant | The employee. Performs the personal care tasks authorized in your care plan, and signs timesheets with you. |
| Communicare Elite (the vendor) | The fiscal and administrative backbone. We handle payroll and taxes, verify program paperwork and background screening, provide your orientation and training, keep required records, and bill MO HealthNet. |
That division of labor is not our invention — it is written into RSMo 208.900, which defines a vendor as an organization providing “monitoring and oversight of the personal care attendant, orientation, and training of the consumer, and fiscal conduit services.”
Who the program is for
CDS is designed for adults with physical disabilities who are capable of directing their own care. In broad terms you need to be 18 or older, eligible for MO HealthNet, physically disabled, able to make your own decisions about your care, and assessed as needing a nursing facility level of care — meaning that without help at home, a nursing facility would be the alternative.
Read the full eligibility requirements →
Who can be your attendant
Missouri law is unusually permissive here, and unusually specific. RSMo 208.900 defines a personal care attendant as “a person, other than the consumer’s spouse, who performs personal care assistance services for the consumer.”
Read that carefully: the only relationship excluded is spouse. Your adult son or daughter, your mother or father, your sister, your cousin, your neighbor, your friend from church — any of them can be hired and paid, provided they clear background screening and complete onboarding.
What CDS is not
CDS is non-medical personal care. Your attendant is not a nurse. They do not give injections, change sterile dressings, deliver physical therapy, or make clinical judgments. If you need skilled care, that is a separate benefit arranged through your physician. See the comparison →
How to begin
- Confirm you are likely eligible — five questions, two minutes.
- Request an assessment from the Department of Health and Senior Services.
- DHSS visits your home and authorizes a care plan.
- Choose Communicare Elite as your vendor.
- Identify your attendant and complete onboarding.
- Your attendant starts work and gets paid on a regular payroll cycle.
Ready to take the next step?
Call (314) 809-6655 for a free consultation, or text (314) 886-5902. We serve St. Louis City, St. Louis County and Missouri communities within about 40 miles of our office.