Missouri Medicaid pays for in-home personal care and related services through 4 programs, including the Aged and Disabled Waiver (ADW) and the Independent Living Waiver (ILW). DHSS Division of Senior and Disability Services administers the ADW, ILW and state plan personal care; DMH runs the DD waivers. ADW applicants may need fee-for-service coverage, so confirm with MO HealthNet. Missouri uses an open EVV model; claims for personal care, homemaker, chore and in-home respite (including MCO-reimbursed) are matched to EVV data.
Yes. MO HealthNet State Plan Personal Care is delivered through an agency model (13 CSR 70-91.010 and 19 CSR 15-7) or a consumer-directed services model (19 CSR 15-8), and personal care claims are matched to EVV data.
Which Missouri waivers can a home care agency bill?
Each waiver below lists who it covers, the services it pays for, and how providers bill.
Aged and Disabled Waiver (ADW)
Population
People age 65 and over, and ages 63-64 with physical disabilities, who would otherwise need nursing home care.
Services covered
homemaker
chore
basic respite
advanced respite
adult day care
home-delivered meals
Billing format
Fee-for-service MO HealthNet claims; homemaker, chore and DSDS-authorized in-home respite require EVV data that integrates with the state EVV Aggregator Solution hosted by Sandata.
Adults 18-64 with a physical or cognitive disability who would otherwise need nursing facility care and meet Consumer-Directed State Plan Personal Care eligibility.
Services covered
consumer-directed personal care beyond state plan limits
financial management services
case management
environmental accessibility adaptations
specialized medical equipment and supplies
Billing format
Fee-for-service MO HealthNet claims; consumer-directed personal care requires EVV through the state Sandata aggregator.
To bill Medicaid for home care you need a state license, a Type 2 NPI, state Medicaid enrollment and screening, waiver or managed care contracts, EVV and authorizations.
Private pay means higher rates and fast payment; Medicaid means steady volume at state-set rates with authorizations and EVV. Compare rates, cash timing and admin before you mix them.
Track units remaining, the end date and the service code for every client, and check them before each schedule change. Hours over the cap are unbillable.
Four units equal one hour. How to convert units to hours, the common HCPCS codes, how states round partial units, and how to stay inside the authorization.
These free tools are made by the team behind Caregiver Scheduling,
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