Missouri home care programs

Home health: the medical benefit

In Missouri, skilled home health is MO HealthNet Home Health Program. It is a medical benefit: a doctor or other practitioner orders nursing, therapy or home health aide visits under a written plan of care, and the visits stop when the skilled need ends.

Only a licensed home health agency enrolled with Missouri Medicaid can bill it, and the agency's own nurses, therapists and aides make the visits.

Home care: non-medical personal care through an agency

Help with bathing, dressing, eating, toileting and household tasks is "home care" or personal care. In Missouri the agency route is Basic and Advanced Personal Care, State Plan (Agency Model) (IHS). No skilled need is required; the person qualifies on functional need, usually measured by an assessment of daily activities.

The agency recruits, trains, schedules and pays the aides, and it is the employer. The aide is agency staff rather than a relative.

Consumer-directed care: the person hires their own aide

Missouri's consumer-directed option is Independent Living Waiver (ILW), Personal Care Assistance, State Plan (Consumer-Directed Services Model) (CDS), and Self-Directed Supports — DD Comprehensive, Community Support, Partnership for Hope and MOCDD waivers (SDS). The person receiving care, or a representative, recruits, hires, trains, schedules and supervises the aide, and can let go of one. A fiscal intermediary runs payroll, taxes and background checks, so the person never handles wages directly.

This is the route most families use to be paid: Independent Living Waiver (ILW), Personal Care Assistance, State Plan (Consumer-Directed Services Model) (CDS), and Self-Directed Supports — DD Comprehensive, Community Support, Partnership for Hope and MOCDD waivers (SDS) allow a relative to be hired as the paid aide. Which relatives qualify (adult children, parents of adults, spouses, legal guardians) and how a live-in caregiver is treated are set program by program.

Structured family caregiving: a paid live-in family caregiver

Missouri offers structured family caregiving through Structured Family Caregiving Waiver (SFCW). A family member who lives with the person provides day-to-day care and is paid a daily stipend rather than hourly wages.

An agency that holds the Medicaid contract enrolls the household, coaches the caregiver, checks in on a set schedule and keeps the care notes. Unlike consumer-directed care, the caregiver does not become anyone's employee by the hour, and the agency, not the family, is the Medicaid provider.

Other ways Missouri pays for care at home

Waiver in-home services: Aged and Disabled Waiver (ADW). These pay for in-home supports for people who meet a nursing-home or similar level of care, often with more services than state plan personal care and, in some programs, a waiting list or enrollment cap.

PACE: Program of All-Inclusive Care for the Elderly (PACE). One PACE organization covers medical care, a day center and home care for people 55 and over who need nursing-home level care.

Which one fits

• Needs nursing, wound care, injections or therapy at home: home health (MO HealthNet Home Health Program).
• Needs daily help and wants an agency to supply and manage the aide: Basic and Advanced Personal Care, State Plan (Agency Model) (IHS).
• Wants to choose the aide, including a relative where allowed: Independent Living Waiver (ILW), Personal Care Assistance, State Plan (Consumer-Directed Services Model) (CDS), and Self-Directed Supports — DD Comprehensive, Community Support, Partnership for Hope and MOCDD waivers (SDS).
• Lives with a family member who provides care most of the day: Structured Family Caregiving Waiver (SFCW).
• Meets nursing-home level of care and needs more than personal care: Aged and Disabled Waiver (ADW).