Many adults with disabilities in Missouri prefer to receive care in their homes or communities instead of nursing homes. However, the cost of home and community-based services (HCBS) can be prohibitive for many low-income individuals. Fortunately, a Medicaid program can help: the Missouri Aged and Disabled Waiver (ADW).
The ADW is a Medicaid program that waives some of the rules of regular Medicaid to provide HCBS to eligible individuals who would otherwise require nursing home care. The ADW aims to prevent or delay institutionalization, promote independence, and improve the quality of life of its participants.
This article covers the ADW, who can qualify for it, what services it covers, and whether it pays family caregivers.
The ADW is one of several Medicaid waivers in Missouri that offer HCBS as an alternative to institutional care. The ADW serves two groups of individuals:
Individuals must meet financial and medical criteria to be eligible for the ADW. They must also live in their own homes or the homes of their relatives or friends. The ADW does not cover assisted living facilities or adult foster care homes.
The ADW provides a range of services and supports tailored to each participant's individual needs and preferences. These services are intended to help participants with their daily activities, personal care, health care, and social needs. The ADW also provides case management to coordinate and monitor the delivery of services.
One of the benefits of the ADW is that it allows participants more choice and control over their care. Participants can choose their providers from a list of approved agencies or opt for a self-directed option that lets them hire their own workers, including family members.
To qualify for the ADW, individuals must meet the following requirements:
The income and asset limits for MO HealthNet vary depending on the applicant's age, marital status, and household size. As of 2023, the monthly income limit for a single elderly or disabled applicant is $903, and the asset limit is $5,000. For married applicants, the income limit is $1,215, and the asset limit is $10,000. Some income and assets may be excluded or disregarded when determining eligibility.
The level of care criteria for nursing home placement is based on assessing the applicant's functional abilities, medical needs, and cognitive status. The assessment is conducted by a nurse from the Department of Health and Senior Services (DHSS) or a contracted agency. The applicant must score at least 21 points on a scale of 0 to 60 to be eligible for the ADW.
The ADW offers various services and supports designed to help participants remain safely and comfortably in their homes or communities. These services include:
The ADW also provides case management services to help participants plan, arrange, and monitor their care. The DHSS or a contracted agency assigns case managers. They conduct assessments, develop service plans, authorize services, coordinate providers, and conduct periodic reviews.
One of the most frequently asked questions about the ADW is whether it pays family caregivers. The answer is yes, but only under certain conditions.
The ADW has two options for service delivery: agency-directed and self-directed. Under the agency-directed option, participants choose their providers from a list of approved agencies that employ qualified workers. Under the self-directed option, participants hire their workers, who can be friends, neighbors, or relatives (except spouses or legal guardians).
The self-directed option gives participants more flexibility and control over their care but also involves more responsibilities. Participants must act as employers and handle recruiting, hiring, training, supervising, paying, and firing their workers. They must also comply with state and federal taxes, insurance, and labor laws.
To participate in the self-directed option, individuals must meet the following requirements:
If participants choose the self-directed option and hire family members as their workers, they can potentially receive compensation for their caregiving. However, the amount of payment depends on several factors, such as:
As of 2023, the hourly pay rate for self-directed workers in Missouri is $12.50 for regular hours and $18.75 for overtime hours. However, this rate may change depending on the state's minimum wage and budget adjustments.
If you are interested in applying for the ADW or finding out if you are eligible for other programs that pay family caregivers, we invite you to fill out this form. We are Givers, a free service that helps caregiving families find and access programs to compensate them for their work. We are here to support you and make your caregiving journey easier.
