8,000+
FreedomCare helps St. Louis County families get paid through Missouri Medicaid for the care they're already giving a parent, sibling, or other loved one at home.
St. Louis County is home to almost a million people, and a large share of them are at the age where staying safe at home takes more help than it used to. If you are looking after an aging parent in Florissant, a spouse in Kirkwood, or an adult child with a disability anywhere in the county, you have probably already run into how confusing Missouri’s Medicaid rules can be. FreedomCare works with St. Louis County families to make sense of those rules and to find out whether Medicaid can pay you for the care you are already giving.
This page explains how Medicaid home care works in St. Louis County, what Missouri’s Consumer Directed Services (CDS) program allows, who tends to qualify, and where to turn locally for help. The programs are run by the state, so the core rules are the same countywide. What changes from one part of Missouri to the next is the local picture, and St. Louis County has one of the largest older populations in the state.
St. Louis County is home to almost a million people, and a large share of them are at the age where staying safe at home takes more help than it used to. If you are looking after an aging parent in Florissant, a spouse in Kirkwood, or an adult child with a disability anywhere in the county, you have probably already run into how confusing Missouri's Medicaid rules can be.
St. Louis County has more residents than any other county in Missouri, and it is also aging. About one in five people here is 65 or older, a higher share than the state as a whole. Most families would rather keep care at home than move someone into a nursing facility. Medicaid home care exists to make that possible. In Missouri, the program that lets a Medicaid member receive personal care at home, and choose who provides it, is Consumer Directed Services. For many St. Louis County families, that choice is a relative they already trust.
Consumer Directed Services is a Missouri Medicaid program run by the Department of Health and Senior Services. Instead of an agency assigning an outside aide on its own schedule, CDS lets the person receiving care act as the employer. They choose their own personal care attendant, set the schedule, and direct the day-to-day work. A CDS provider like FreedomCare handles the paperwork behind it, including payroll, tax withholding, and background checks.
CDS covers non-medical personal care, the hands-on help that makes daily life manageable. It does not cover skilled nursing or therapy, which fall under home health care instead. A CDS attendant in St. Louis County typically helps with:
CDS is for adults who are enrolled in MO HealthNet, Missouri's Medicaid program, and who need help with everyday activities because of age, a disability, or a chronic health condition. The state's Division of Senior and Disability Services completes an in-home assessment to confirm eligibility and to decide how many hours of care a person is approved for. That assessment is based on real need, so the number of hours varies from one person to the next.
This is the question most St. Louis County families ask first, so here is the direct answer. Under Missouri's CDS program, the paid attendant can be a family member, a friend, or a neighbor, as long as that person is at least 18 and passes the required background checks. An adult child caring for a parent is a common and accepted arrangement, and so is a sibling, grandchild, or trusted neighbor.
There is one important limit. In Missouri, a spouse cannot be paid as a CDS attendant, and neither can a legal guardian. If you are caring for a husband or wife, the CDS attendant would need to be someone else. Spouse and family caregiver rules differ from state to state and from program to program, so it is worth confirming the current rule for any specific situation before counting on it.
| Generally allowed | Not allowed as a paid CDS attendant |
|---|---|
| Adult child caring for a parent | Spouse (husband or wife) |
| Other relatives, such as a sibling, grandchild, or in-law | A legal guardian of the person receiving care |
| A trusted friend or neighbor (age 18 or older) | Anyone who does not pass the required background checks |
Each attendant must clear a background check, including the Missouri Family Care Safety Registry. A CDS member may use up to four attendants. Rules are set by the state and can change.
| Consumer Directed Services | Traditional agency home care | |
|---|---|---|
| Who provides care | Someone the member chooses, often a relative or friend | An aide assigned by the agency |
| Who sets the schedule | The member directs the schedule and tasks | The agency manages scheduling |
| Type of care | Non-medical personal care | Personal care, sometimes alongside skilled care |
Both are paid through Missouri Medicaid. CDS is built around the member choosing and directing their own caregiver.
CDS does not stand alone. It sits inside a set of Missouri Medicaid programs, and it helps to know how the pieces fit together.
MO HealthNet is the name of Missouri's Medicaid program. It is the coverage a person must have before any Medicaid home care can begin. MO HealthNet is not the same as Medicare. Medicare is federal health insurance tied mainly to age, and it does not pay for ongoing personal care at home. MO HealthNet is income and asset based, and it is the program that funds long-term home care. Many families discover this difference only after a hospital discharge, when they are trying to figure out what will actually be covered. You can learn more about MO HealthNet through the state's MO HealthNet / MyDSS.
Home and Community Based Services, usually shortened to HCBS, are Medicaid services that let a person receive care at home rather than in an institution. Missouri runs HCBS through two separate agencies, and that distinction matters for families. The Department of Health and Senior Services administers waivers for older adults and people with physical disabilities, including the Aged and Disabled Waiver and the Independent Living Waiver. Separately, the Department of Mental Health's Division of Developmental Disabilities runs HCBS waivers for people with intellectual and developmental disabilities, including the Comprehensive Waiver and the Partnership for Hope. If you are caring for an adult child with a developmental disability, that side of the system is where to start.
Missouri also covers personal care assistance through its Medicaid State Plan. Consumer Directed Services can be delivered through State Plan personal care or through a waiver such as the Independent Living Waiver, depending on a person's situation and level of need. The practical takeaway for most St. Louis County families is simpler than the program names suggest: if a Medicaid member needs help with daily activities at home, there is usually a pathway to cover it, and an assessment determines which one fits.
A few misunderstandings come up again and again, and they stop families from getting help they may qualify for.
"Medicare will cover this." Medicare generally does not pay for ongoing personal care at home. That kind of long-term help comes through Medicaid, which in Missouri is MO HealthNet.
"We own a home, so we won't qualify." Medicaid eligibility looks at several factors, and a primary home is treated differently from other assets. Owning a house does not automatically rule a person out. The only way to know is to apply and be assessed.
"Family can't get paid for this." In Missouri, family members other than a spouse often can be paid to provide care through CDS. An adult child caring for a parent is one of the most common arrangements in the program.
"It's the same as a nursing home, just at home." CDS is non-medical personal care directed by the person receiving it. It is designed to help people stay in their own homes and out of facilities for as long as it safely works.
St. Louis County's size and age profile shape how much Medicaid home care is needed here. A few figures help put the local picture in context.
St. Louis County has a strong network of local offices and organizations that help older adults, people with disabilities, and the family members caring for them. These are good places to start, alongside FreedomCare.
FreedomCare works with families across Missouri, including St. Louis County, who want to be paid for the care they are giving at home. We are not a nursing home, and we are not an agency that sends a stranger to your door. We support the consumer-directed model, where the person receiving care chooses someone they already trust.
In practice, that means we help with the parts that tend to overwhelm families. We help you understand whether CDS is a fit and what the eligibility process looks like. We guide the caregiver through onboarding and the required background checks. Once care begins, we handle payroll and tax withholding so the caregiver gets paid correctly and on time. And we stay available when questions come up later, because they will.
Yes. Missouri Medicaid, known as MO HealthNet, pays for non-medical personal care at home through programs such as Consumer Directed Services. A St. Louis County resident who is enrolled in MO HealthNet and assessed by the state as needing help with daily activities can receive home care funded by Medicaid.
In many cases, yes. Missouri's CDS program allows the person receiving care to choose their own attendant, and that attendant can be a relative, friend, or neighbor who is at least 18 and passes the required background checks. An adult child caring for a parent is a common arrangement.
No. Under Missouri's CDS program, a spouse cannot be paid as a personal care attendant, and neither can a legal guardian. Another relative, such as an adult child, can usually serve in that role instead. Caregiver rules vary by state, so confirm the current rule for your situation.
MO HealthNet is Missouri's Medicaid program, and it is income and asset based. It funds long-term personal care at home. Medicare is federal health insurance tied mainly to age, and it generally does not cover ongoing personal care. Home care for daily activities is paid through MO HealthNet, not Medicare.
If you are not yet enrolled in MO HealthNet, that is the first step. You can apply through Missouri's MyDSS portal. Once enrolled, the state's Division of Senior and Disability Services completes an in-home assessment to determine eligibility for CDS and how many hours of care are approved. FreedomCare can walk you through each step.
There is no single answer. The number of approved hours is set by the state's in-home assessment and is based on how much help a person needs with daily activities. Two people in the same neighborhood can be approved for very different amounts of care.
FreedomCare works with families across Missouri, including St. Louis County. We help eligible families understand Consumer Directed Services, get caregivers onboarded, and manage payroll so care can continue at home.
If you are caring for someone in St. Louis County and you are not sure whether Medicaid can help, the next step is simple. Reach out to FreedomCare. We will talk through the person's situation, explain how Consumer Directed Services works, and help you figure out whether it is worth pursuing. There is no cost to ask, and getting a clear answer is far better than guessing.
You have been doing the hard part already. Let us help you find out whether Missouri Medicaid can support the care you are giving.
Important Disclaimer: This page is general information, not legal, financial, or medical advice. Eligibility for MO HealthNet and Consumer Directed Services is determined by the State of Missouri, and approval is never guaranteed. Program rules, covered services, and caregiver requirements can change. Spouse and family caregiver rules vary by state and by program. Confirm current details with the Missouri Department of Health and Senior Services or the Family Support Division before making decisions.
Apply for Missouri Medicaid and learn what MO HealthNet covers.
mydss.mo.gov/mhdState overview of the CDS program, including how it works and who it serves.
health.mo.gov/seniors/hcbs/cds.phpInformation on Medicaid services that support care at home instead of in a facility.
health.mo.gov/seniors/hcbs/Information on Missouri's four HCBS waivers for people with intellectual and developmental disabilities.
dmh.mo.gov/dev-disabilities/programs/waiverArea Agency on Aging serving St. Louis County, with meals, in-home services, and caregiver support.
agingahead.orgStatewide directory of Area Agencies on Aging.
health.mo.gov/seniors/aaa/State resources for older adults and the families who care for them.
health.mo.gov/seniors/Third-party explainer covering Missouri's Personal Care Program eligibility, benefits, and application process.
medicaidplanningassistance.org/missouri-personal-care-program/Free civil legal help, including public benefits assistance, for eligible St. Louis County residents.
lsem.orgCounty population, age, income, poverty, and health insurance statistics.
census.gov/quickfacts/stlouiscountymissouriCounty-level data on health outcomes, access to care, and related factors.
countyhealthrankings.orgIndependent data on Medicaid enrollment and spending by state.
kff.org/state-category/medicaid-chip/We’ll help you find the right program for your family.
Why Families Choose FreedomCare
We help families across Missouri every day.
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Why Families Choose FreedomCare
We help families across Pennsylvania every day.
You’ve been caring for your loved one because it’s the right thing to do. FreedomCare can help you navigate Missouri’s CDS program, understand your options, and take the first step toward care from someone you trust while they get paid for it.
