Do you qualify for Consumer Directed Services?
Five requirements decide it. You need to meet all five. The Department of Health and Senior Services makes the final determination — Communicare Elite cannot approve or deny anyone — but you can usually tell from these questions whether it is worth requesting an assessment.
The five requirements
1. You are 18 or older
CDS is an adult program. There is no upper age limit — a 92-year-old and a 24-year-old qualify on the same terms.
2. You are eligible for MO HealthNet
MO HealthNet is Missouri’s Medicaid program, and it is what pays for CDS. If you are not currently enrolled, you would need to apply and be found eligible. Eligibility depends on income, assets and disability status.
3. You have a physical disability
Missouri law describes this as loss, or loss of use, of neurological, muscular or skeletal function to a degree that requires assistance with routine daily tasks. Common qualifying conditions include spinal cord injury, multiple sclerosis, muscular dystrophy, cerebral palsy, stroke with lasting deficits, advanced arthritis, amputation, ALS and Parkinson’s disease — but the label matters less than the functional limitation.
4. You can direct your own care
This is the requirement people misunderstand most. CDS asks you to act as an employer: to decide what help you need, instruct your attendant, verify hours and sign timesheets. You do not need to be physically able to do any of it yourself — you need to be able to make and communicate the decisions.
RSMo 208.900 excludes people who have a legal limitation on their ability to make decisions, such as an appointed guardian or conservator. A 2009 federal court decision found that excluding people with mental disabilities who required guardianship violated federal law, so if guardianship is part of your situation, ask rather than assume.
5. You are assessed at a nursing facility level of care
The Division of Senior and Disability Services assesses whether your needs are at the level that would otherwise justify nursing facility placement. The program exists so that people who would qualify for a nursing home can stay in their own homes instead.
What does not disqualify you
Several widely believed disqualifiers are simply not requirements:
- Living with family. You can live with your adult children, your parents, or anyone else and still qualify.
- Having a family member as your attendant. Encouraged, in fact — as long as they are not your spouse.
- Owning your home. Home ownership is not an asset test failure in itself for MO HealthNet purposes.
- Being employed. Working does not disqualify you, and essential transportation to a job can be an authorized task.
- Already receiving some other services. Ask — many combinations are permitted.
If you are not sure
Call us. A five-minute conversation costs nothing and usually resolves it. If you are clearly not eligible, we will tell you so and point you somewhere more useful rather than starting paperwork that will not go anywhere.
Frequently asked questions
Who actually decides if I am eligible?
The Missouri Department of Health and Senior Services, through its Division of Senior and Disability Services. They perform the in-home assessment and authorize the care plan. A vendor cannot approve you, and any vendor who implies otherwise is misrepresenting the program. See how the assessment works.
I have a guardian. Am I automatically excluded?
Not necessarily. The statute’s exclusion language has been limited by litigation, and situations vary. Ask DHSS directly rather than assuming — call the HCBS line at 866-835-3505.
Does a mental health diagnosis disqualify me?
The program’s eligibility is built around physical disability and the ability to direct your own care. A mental health diagnosis by itself neither qualifies nor disqualifies you; what matters is physical function and decision-making capacity.
What if I qualify but do not have anyone to hire?
Tell us. We recruit attendants throughout the St. Louis area and can bring you candidates to interview. You still make the hiring decision. How choosing an attendant works.