Getting approved for MO HealthNet can be an important milestone when you or a loved one needs additional care. But if your goal is receiving help at home, Medicaid approval is not necessarily the end of the process.
Missouri’s Home and Community-Based Services, commonly called HCBS, help eligible older adults and people with disabilities receive support in their homes and communities rather than moving into an institutional setting.
If you have active MO HealthNet coverage and believe you or a family member could benefit from home care, here is what happens next.
Step 1: Make Sure Your MO HealthNet Coverage Is Active
Active Medicaid coverage is generally required for Medicaid-funded HCBS administered by the Missouri Department of Health and Senior Services.
MO HealthNet is Missouri’s Medicaid program. If you have applied but your coverage is still pending, you may need to wait for an eligibility determination before Medicaid-funded HCBS can begin.
If you are unsure about your current Medicaid status, contact the Missouri Family Support Division at 855-373-4636 or review your benefits through the state’s MO HealthNet resources.
If you have not applied yet, start with the Missouri Department of Social Services’ MO HealthNet application.
Step 2: Request Home and Community-Based Services
Having Medicaid coverage does not automatically enroll you in HCBS.
The next step is making an HCBS referral to Missouri’s Division of Senior and Disability Services, or DSDS. A referral can be made for someone who is not currently authorized to receive HCBS.
Participants, family members, friends, and other informal support systems can contact DSDS about a referral. Missouri also allows HCBS providers and professional community partners to submit referrals.
You can learn more about Missouri HCBS referrals and eligibility through the Department of Health and Senior Services.
Step 3: Complete Your HCBS Assessment
After the referral process begins, Missouri determines whether the individual is appropriate for an initial assessment.
An assessment is used to understand the person’s health, abilities, current support system, and unmet care needs. Missouri uses the interRAI Home Care assessment as part of this process.
For Medicaid-funded HCBS administered through DSDS, an individual must meet Missouri’s nursing facility Level of Care criteria. The state currently uses a Level of Care score of 18 or higher to satisfy this requirement.
This does not mean someone must live in a nursing facility. The purpose of HCBS is the opposite. These services are designed to help eligible individuals receive necessary assistance while remaining in the least restrictive setting possible, including their own home.
Step 4: Develop a Person-Centered Care Plan
If you qualify for HCBS, the process moves into developing a Person-Centered Care Plan, or PCCP.
This plan is based on your assessed needs and the support already available to you. It identifies unmet needs that may be addressed through authorized HCBS.
Depending on eligibility and individual needs, Missouri HCBS can include services such as:
- Help with bathing, dressing, and grooming
- Meal preparation and assistance
- Household tasks
- Advanced personal care
- Respite care
- Home-delivered meals
- Certain transportation assistance
- Adult day care
- Certain medical supplies and equipment
- Home modifications
Step 5: Understand Your Home Care Options
Once services have been authorized, you can begin looking at the care arrangement and qualified provider options available to you.
For some eligible Missourians, that may include traditional in-home care. Others may qualify for Consumer Directed Services, commonly known as CDS.
CDS gives eligible participants greater responsibility for directing their personal care services, including recruiting, hiring, and supervising their attendant. Because CDS has additional program requirements, eligibility for HCBS does not necessarily mean an individual will qualify for or choose consumer-directed care.
Kingdom Care works with St. Louis-area families across different home care needs, including Medicaid-covered home care, Consumer Directed Services, and private pay support.
Step 6: Keep Your Care Plan Up to Date
Your needs today may not be the same six months or a year from now.
Missouri allows HCBS participants to request changes to their care plans when their needs change. The state also conducts eligibility reviews to determine whether participants continue to meet program requirements.
If your health, living situation, or ability to complete daily activities changes, communicating those changes can help make sure your care plan continues to reflect your current needs.
Compassionate Care Starts With Understanding Your Options
Navigating Medicaid and home care can involve several steps, but each one has a purpose: helping determine what level of support is appropriate for you or your loved one.
At Kingdom Care, we believe home care should be built on trust, integrity, and respect for every family’s individual needs. Whether you are exploring Medicaid-covered home care, Consumer Directed Services, or private pay care, our team is here to help you understand your options and take the next step with confidence.
Looking for home care in St. Louis County or the surrounding area? Contact Kingdom Care to learn more about our services and how we can support your family at home.
Kingdom Care does not determine Medicaid or HCBS eligibility or guarantee authorization of services. Eligibility, assessments, care plans, and service authorizations are determined by the appropriate Missouri state agencies in accordance with applicable program requirements. Services available to an individual may vary.
