Overview of Missouri’s Personal Care Program
Missouri’s Personal Care (PC) Program, or Personal Care Services Program, provides in-home personal care services for adult state residents (18+ years old) with chronic health issues and / or physical disabilities. Intended to prevent or delay the need for hospitalization or nursing facility care, assistance with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) is provided. This includes bathing, dressing, toileting, mobility, changing bed linens, laundry, and preparing meals. Program participants may also receive authorized nurse visits, which includes prevention / maintenance services, such as filling pill boxes or insulin syringes for the program participant to self-administer.
While program participants can receive their personal care services via agency providers, which is formally called the Personal Care – Agency Model, there is also a Consumer-Directed Model. This self-directed option is also called the Consumer-Directed Personal Care Assistance Program or Personal Care Assistance Consumer-Directed Services (CDS) Program. CDS allows program beneficiaries to hire, train, and manage their own personal care attendant (caregiver). This could be a relative, including one’s adult child, but not a spouse or guardian.
Personal care assistance can be provided in one’s home, a Residential Care Facility (RCF), or Assisted Living Facility (ALF). Note that Missouri does not license Adult Foster Care Homes. For Consumer Directed Services, persons are prohibited from living in a RCF or ALF.
The Personal Care Program is an entitlement program; meeting eligibility requirements equates to immediate receipt of program benefits. Stated differently, there is never a waitlist to receive personal care assistance.
Medicaid in Missouri is also MO HealthNet. The Personal Care Program is part of MO’s State Plan Medicaid. One might also hear this program called State Plan Personal Care (SPPC).
While home and community based services (HCBS) can be provided via a Medicaid Waiver or a state’s Regular Medicaid Plan, HCBS through Medicaid State Plans are an entitlement. Meeting the program’s eligibility requirements guarantees an applicant will receive benefits. On the other hand, HCBS via Medicaid Waivers are not an entitlement. Waivers have a limited number of participant enrollment slots, and once they have been filled, a waitlist for benefits forms. Furthermore, HCBS Medicaid Waivers require a program participant require the level of care provided in a nursing home, while State Plan HCBS does not always require this level of care.
Benefits of the Personal Care Program
The following services and supports are available via the PC Program. The exact benefits and the frequency with which assistance is provided is based on an individualized personal care plan.
– Authorized Nurse Visits – increased supervision, health evaluations, and preventative / maintenance services (i.e., filling insulin syringes and pill boxes for a participant’s self-administration)
– Bathing / Sponge Baths / Showering
– Meals – planning, preparing, and clean-up
– Dressing – putting on & taking off clothing
– Grooming / Personal Hygiene – shampooing and combing hair, shaving, nail care, denture care, brushing teeth
– Mobility – getting in / out of wheelchair, walking from one room to another
– Assisted Device Use for Transfers
– Self-Administered Medications – assistance with opening a medication bottle, getting a glass of water
– Application of prescription / non-prescription lotions and ointments to non-broken skin
– Shopping – for groceries and other essential items
– Toileting – using the toilet and cleaning up oneself
– Ostomy / Catheter Care
– Eating – using a fork and getting food in the mouth, drinking from a glass
– Housekeeping – laundry, changing bed linens, trash, dusting, cleaning floors
– Passive Range of Motion
Eligibility Requirements for Missouri’s Personal Care Program
The Personal Care Program is for MO residents who are 18 years of age and older. An applicant must have a chronic health issue (i.e., diabetes, arthritis) that results in the need for personal care assistance. For Consumer-Directed Personal Care, an applicant must have a physical disability, and as a result, require assistance to do daily activities. One must also be able to self-direct their own care. Furthermore, all applicants must be eligible and enrolled in Medicaid. The Medicaid eligibility criteria that follows is relevant for seniors.
Financial Criteria: Income, Assets & Home Ownership
Income
The applicant income limit is equivalent to 85% of the Federal Poverty Level (FPL). While this figure increases annually in January, for MO Medicaid, the income limits increase each April. For aged or disabled Medicaid, effective 4/1/24 – 3/31/25, the income limit is $1,067 for a single applicant. Married couples, regardless of if one or both spouses are applicants, can have a monthly income up to $1,448.
Assets
In 2024, the asset limit is $5,909.25 for a single applicant. For married couples, the asset limit is $11,818.45. This hold true whether one or both spouses are applicants.
Some assets are not counted towards Medicaid’s asset limit. These generally include an applicant’s primary home, household furnishings and appliances, personal effects, and a vehicle.
While there is a 60-month Look-Back Rule in which Medicaid checks past asset transfers of those applying for Nursing Home Medicaid or home and community based services via a Medicaid Waiver, there is no “look back” for this program.
Home Ownership
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Medicaid will take it. For eligibility purposes, Missouri Medicaid considers the home exempt (non-countable) in the following circumstances.
– The applicant lives in the home or has Intent to Return and their home equity interest is no greater than $713,000. Home equity is the current value of the home after subtracting any debt against it. Equity interest is the portion of the home’s equity value that is owned by the applicant.
– The applicant has a spouse who lives in the home.
– The applicant has a minor child (under 21 years old) who lives in the home.
– The applicant has an adult child (21+ years old ) who is blind or disabled (permanently and totally) who lives in the home.
Learn more about the potential of Medicaid taking the home.
Medical Criteria: Functional Need
An applicant must require a Nursing Facility Level of Care to be eligible for the Personal Care Program. Essentially, an applicant would require nursing home admission if personal care assistance were not provided.
Qualifying When Over the Limits
Having income and / or assets over Medicaid’s limit(s) does not mean an applicant cannot still qualify for Medicaid / MO HealthNet. There are a variety of planning strategies that can be used to help persons who would otherwise be ineligible to become eligible. Some of these strategies are fairly easy to implement, and others, exceedingly complex. Below are the most common.
Missouri Medicaid has a Medically Needy Program for Medicaid applicants who have high medical expenses relative to their income. Also called a Spend down program, applicants are permitted to spend “excess” income on medical expenses and health care premiums, such as Medicare Part B, in order to become income-eligible for Medicaid. This can be thought of as a deductible. In MO, one also has the option of paying the spend down amount outright to the state rather than submitting medical bills to meet their spend down.
When persons have assets over the limits, Irrevocable Funeral Trusts (IFTs) are an option. IFTs are pre-paid funeral and burial expense trusts that Medicaid does not count as assets. Persons can also “spend down” assets on home improvements (i.e., updating plumbing, replacing a water heater), home modifications (i.e., adding a first floor bedroom, addition of grab bars), and replacing an older car with a newer one. There are many other options when the applicant has assets exceeding the limit.
Inadequate planning or improperly implementing a Medicaid planning strategy can result in a denial or delay of Medicaid benefits. Professional Medicaid Planners are educated in the planning strategies available in Missouri to meet Medicaid’s financial eligibility criteria without jeopardizing Medicaid eligibility. Furthermore, while Medicaid’s 60-month Look-Back Rule is not applicable to the Personal Care Program, some applicants will require more extensive care, such as Nursing Home Medicaid or home and community based services via a Medicaid Waiver in the future. For these programs, the Look-Back Rule is relevant. Therefore, while there are many planning strategies, they should only be implemented with careful planning and well in advance of the need for long-term care. However, there are some workarounds, and Medicaid Planners are aware of them. For these reasons, it is highly suggested one consult a Medicaid Planner for assistance in qualifying for Medicaid when over the income and / or asset limit(s).
How to Apply for the Personal Care Program
Before You Apply
Prior to submitting an application for the Personal Care Program, applicants need to ensure they meet the eligibility criteria for MO Medicaid. Applying when over the income and / or asset limit(s) will be cause for denial of benefits. The American Council on Aging offers a free Medicaid Eligibility Test to determine if one might meet Medicaid’s eligibility criteria.
As part of the application process, applicants will need to gather documentation for submission. Examples include copies of Social Security and Medicare cards, proof of income, copies of life insurance policies, property deeds, and pre-need burial contracts. A common reason applications are held up is required documentation is missing or not submitted in a timely manner.
Application Process
To apply for the Personal Care Program, applicants must be enrolled in Missouri’s Medicaid program. Persons can apply for MO HealthNet online, via phone at 855-373-9994, or by submitting a completed Application for Health Coverage & Help Paying Costs. Persons 65+ years old must also complete an Aged, Blind, and Disabled Supplement.
For application assistance and / or program information, persons can reach the Family Support Division (FSD) Call Center at 855-373-4636. Alternatively, persons can receive help at their local FSD office.
Persons enrolled in MO HealthNet should submit a referral for Personal Care Services / Consumer-Directed Personal Care Assistance. This can be done using the Online HCBS Referral Form, by calling 866-835-3505, or by submitting a completed HCBS 1-Form. As part of the application process, an in-home assessment will be completed.
Learn more about the Personal Care Program: Agency Model and Consumer-Directed Model. More on Personal Care in Assisted Living Facilities / Residential Care Facilities.
The Missouri Department of Social Services (DSS) Family Support Division (FSD) determines financial eligibility for MO HealthNet. The Missouri Department of Health & Human Services’ Division of Senior and Disability Services (DSDS) determines if one is functionally eligible for the Personal Care Program.
Approval Process & Timing
The Medicaid application process can take up to 3 months, or even longer, from the beginning of the application process through the receipt of the determination letter indicating approval or denial. Generally, it takes one several weeks to complete the application and gather all of the supportive documentation. If the application is not properly completed, or required documentation is missing, the application process will be delayed even further. Based on federal law, Medicaid offices have up to 45 days to review and approve or deny one’s application (up to 90 days for disability applications). Despite the law, applications are sometimes delayed even further.