MO Community Support Waiver

Published on
August 23, 2023
Last updated
February 29, 2024
Written by
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Katie Wilkinson
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The Community Support Waiver is a Medicaid program that offers home and community-based services and supports to people with developmental disabilities who live in the community, usually with their families to prevent or delay institutionalization and promote independence and inclusion.
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If you are a family caregiver of a person with a developmental disability, you may wonder how to access the resources and assistance you need to provide quality care. You may also be curious about how much family members get paid for caregiving, how much Medicaid pays for a caregiver, or how to get paid to be a caregiver for parents. In this article, we explore one of the options available to you in Missouri: the Community Support Waiver.

The Community Support Waiver is a Medicaid program that offers home and community-based services and supports to people with developmental disabilities who live in the community, usually with their families. The waiver aims to prevent or delay institutionalization and promote independence and inclusion. The waiver can serve both adults and children who meet specific eligibility criteria. The waiver has an annual service cost limit of $40,000 per participant.

Overview of Community Support Waiver

The Community Support Waiver is one of the four waivers administered by the Missouri Division of Developmental Disabilities (DD). The waiver began in July 2003 and serves over 3,800 individuals as of 2023. The waiver is partly funded by federal dollars through the Centers for Medicare and Medicaid Services (CMS).

The purpose of the waiver is to provide an alternative to institutional care for people with developmental disabilities who are at risk of needing intermediate care facilities for individuals with intellectual disabilities (ICF/ID). The waiver allows participants to receive services and support in their own homes or other community settings that are less restrictive and more integrated than institutional settings. The waiver also gives participants more choice and control over their services and supports through a self-direction option.

The target population of the waiver is people with developmental disabilities who have a place to live in the community, usually with their families. A developmental disability is defined as a disability that is attributable to intellectual disability, cerebral palsy, autism, epilepsy, head injury, or a similar condition; that occurred before age 22; that will probably continue indefinitely; and that results in meaningful functional limitations in two or more areas of major life activities.


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Eligibility Requirements

To be eligible for the Community Support Waiver, an individual must meet the following requirements:

  • Have a developmental disability as defined above.
  • Meet the ICF/ID level of care criteria.
  • Be at risk of needing ICF/ID services if waiver services are not provided
  • Have an annual income below 300% of the Supplemental Security Income (SSI) federal benefit rate ($2,382 monthly in 2023).
  • Have countable resources below $5,000 for an individual or $10,000 for a couple
  • Be a Missouri resident and a US citizen or qualified alien.
  • Be enrolled in MO HealthNet (Missouri Medicaid)
  • Have an individual support plan (ISP) that identifies the need for waiver services and supports
  • Have an annual service cost below $40,000

Services and Supports

The Community Support Waiver offers a range of services and supports designed to meet each care recipient's individual needs and preferences. The services and supports are intended to help participants achieve their personal goals and outcomes related to health, safety, independence, community participation, and quality of life. The services and supports include:

  • Adaptive equipment: Items that assist participants in performing activities of daily living or increase their safety or mobility
  • Adult day health care: Structured day programs that provide health monitoring, personal care, socialization, recreation, and transportation
  • Assistive technology: Devices or software that enhance participants' communication, learning, or functioning
  • Behavior intervention: Services that address challenging behaviors that interfere with participants' health or safety or prevent them from accessing other services
  • Career planning: Services that help participants explore their vocational interests and abilities and develop employment goals
  • Community integration: Services that assist participants in accessing community resources and activities that are consistent with their preferences
  • Community specialist: Services that provide training and support to participants in areas such as self-care, social skills, money management, household management, etc.
  • Crisis intervention: Services that provide immediate response and stabilization for participants who experience a behavioral or emotional crisis
  • Environmental accessibility adaptations: Modifications to participants' homes or vehicles that improve their accessibility or safety
  • Individualized skill development: Services that teach participants specific skills related to employment or independent living
  • Personal assistant: Services that assist with activities of daily living like bathing, dressing, eating, etc.
  • Respite: Services that provide temporary relief to unpaid caregivers who are responsible for the care of participants
  • Self-directed supports: Services that allow participants to hire and manage their workers, such as personal assistants, community specialists, or respite providers
  • Specialized medical equipment and supplies: Items that are necessary for the treatment or management of participants' medical conditions
  • Supported employment: Services that help participants find and maintain paid work in integrated settings
  • Support broker: Services that assist participants who choose self-directed support with managing their workers and budgets
  • Transportation: Services that provide non-emergency transportation to participants who need access to waiver or other community services

Who are you caring for?

Compensation for Caregivers

One of the benefits of the Community Support Waiver is that it allows participants to choose self-directed support for some of the services they receive. Self-directed support gives participants more choice and control over their services and supports by hiring and managing their workers. Participants can use a fiscal intermediary agency to handle the payroll and taxes for their workers.

Self-directed support also allows participants to hire their family members as paid caregivers, so long as they are not legally responsible for the participant (such as a parent of a minor child) or living in the same household as the participant (unless an exception is granted). Family caregivers can be paid for providing personal assistant, community specialist, or respite services to the participant. The payment rates vary depending on the type and level of service provided, but they are generally based on the prevailing wage in the area.

Family caregivers who are interested in becoming paid workers for their loved ones must meet the following requirements:

  • Be at least 18 years old.
  • Have a valid Social Security number and driver's license or state ID.
  • Pass a criminal background check and a family care safety registry check.
  • Complete an orientation and training program.
  • Sign a worker agreement and a code of ethics.
  • Follow the participant's support plan and budget.

Family caregivers who become paid workers must also comply with the rules and regulations of the waiver program, such as submitting timesheets, keeping records, reporting incidents, etc. They must also respect the participant's rights and preferences and provide quality care.

A Note from Givers

Suppose you are a family caregiver of a person with a developmental disability who lives in Missouri. In that case, you may be eligible for this waiver program that provides valuable services and support, including compensation for your caregiving work. To find out if you qualify, please fill out this form, and we will contact you soon. 

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