Getting paid to care for a family member in Missouri
If you are already helping a parent bathe, driving a sibling to dialysis, or cooking every evening for an adult child with a disability, you are doing a job. Missouri’s Consumer Directed Services program can turn that into paid employment.
The one rule that stops people
Under RSMo 208.900, a personal care attendant is “a person, other than the consumer’s spouse.” That is the entire family restriction.
Can be paid
- Adult son or daughter
- Mother or father
- Brother or sister
- Grandchild, niece, nephew, cousin
- In-laws
- Friend or neighbor
Cannot be paid
- Husband or wife of the consumer
That is the whole list. If someone has told you that Missouri prohibits paying family generally, they have confused CDS with a different program or a different state.
How it actually works
- The person receiving care has to qualify, not you. They must meet the CDS eligibility requirements — 18 or older, MO HealthNet eligible, physically disabled, able to direct their own care, and assessed at a nursing facility level of care. See the requirements.
- They request a DHSS assessment and receive an authorized care plan. The referral line is 866-835-3505.
- They hire you and name Communicare Elite as their vendor.
- You complete onboarding — employment paperwork, tax forms, background screening and orientation. What that involves.
- You are paid as an employee on a regular payroll cycle, with taxes withheld and a W-2 at year end. You are not a contractor and you are not paid in cash.
What this changes, and what it does not
What changes: the hours you were giving away become compensated, with a real pay stub, tax withholding and an employment record. For many families that is the difference between someone leaving a job to provide care and being able to afford to provide it.
What does not change: you still have to do the work, and only the authorized tasks count. The program pays for personal care delivered under an authorized plan — not for being related to someone, and not for being on call.
You cannot be paid for time you did not work. Both of you sign the timesheet, and both of you are responsible for its accuracy. Signing for unworked hours is Medicaid fraud. This is the single most common way well-meaning families get into serious trouble. Read this before you start →
Honest disadvantages
It is worth knowing these before you commit:
- Income affects benefits. Earned income can affect your own eligibility for income-tested programs. Check before you assume.
- Roles blur. Being your mother’s employee and her child at the same time is genuinely awkward for some families. Talk about it in advance.
- Hours are capped by the care plan, not by how much care you actually give. Most family caregivers give more than the plan authorizes.
- You cannot bill while they are hospitalized or otherwise not receiving care at home.
Start the conversation
Frequently asked questions
Can I be paid to care for my husband or wife?
No. The spousal exclusion is written into Missouri law and there is no waiver for it in the CDS program. Other relatives can be paid.
Can two family members split the hours?
Yes — a consumer can employ more than one attendant, within the total authorized hours. Many families divide weekdays and weekends this way.
Do I need a certification or license?
No. CDS is non-medical personal care and does not require a nursing certificate. You do need to pass background screening and complete orientation. See what is required.
Will I get a W-2?
Yes. You are an employee, not a contractor. Taxes are withheld and a W-2 is issued at year end. How pay works.
My parent has dementia. Do they still qualify?
The program requires the consumer to be able to direct their own care, and excludes people with a legal limitation on decision-making such as a guardianship. Dementia complicates that test. Ask DHSS directly at 866-835-3505 rather than assuming either way.