Home and Community-Based Services (HCSB) waivers allow individuals to receive long-term care and support services in their homes or community settings rather than institutions or nursing facilities. These programs are designed to help participants maintain or improve their overall quality of life.
If you or someone you care for may be eligible for a waiver, review the guidelines below to understand how this process works. You can also use the step-by-step Missouri HCBS Waiver Finder to help determine which waiver option fits your needs best.
General Eligibility and Limitations for All Waivers
All waiver participants must meet these requirements:
- Reside in Missouri
- Have active MO HealthNet coverage for waiver services
- Access other available services and supports (paid and unpaid) first, including Medicaid State Plan services
- Meet and follow all waiver program and service rules
- Agree to eligibility re-evaluation at least every 365 days, or as needed
Specific waivers may enforce additional eligibility criteria based on age, level of care, or diagnosis.
General Program Limitations
All waiver participants must comply with the following state and federal limitations:
- Cannot reside in jail, nursing home, Intermediate Care Facility for Individuals with Intellectual Disabilities, or other institutional setting
- Cannot be enrolled in two Home and Community-Based Services (HCBS) waivers at the same time
- Cannot receive HCBS services while hospitalized (unless specified in the waiver)
Transitioning to a Different Waiver
As a participant’s situation or age changes, they may need to transition from one waiver to another. Transitioning can also occur if a participant's underlying medical condition, care level requirements, or financial eligibility changes. If you anticipate a needed transition, use the Missouri HCBS Waiver Finder to evaluate which waiver offers the appropriate level of care.
MO HealthNet Common Age-Based Transition Milestones
Transition to Adult Programs
Assessment for Adult Services
Education Support Options
Continued Eligibility Check
Workforce Training & Support
Post-Secondary Goals
Preparing for Senior Care
Review of Benefits & Options
Long-Term Planning
Senior Services Activation
Medicare Coordination
HCBS Continuity Assessment
When Waiver Services are Discontinued
Waiver services will be discontinued under any of the following circumstances:
- The participant passes away.
- The participant is admitted to a nursing facility or institutional care setting.
- The participant no longer meets the underlying medical, institutional level of care, or financial eligibility criteria.
- The participant transitions into a different HCBS waiver program.
- The participant can no longer be safely maintained in a home or community setting.
Waiver Information
While the MO HealthNet Division (MHD) serves as the single state Medicaid agency overseeing all waivers, individual waiver programs are operated day-to-day by different state agencies. Knowing which agency handles your waiver ensures you reach out to the correct team with questions. Review the below for information on each waiver, including who to contact to apply and for questions.
Department of Health & Senior Services Waivers
- Adult Day Care Waiver (ADCW)
Adult Day Care Waiver (ADCW)
The Adult Day Care Waiver was developed to provide a community-based alternative to individuals with a disability, ages 18 through 63 years of age, who otherwise would be institutionalized in a nursing facility.
Eligibility:
- Meet all general waiver eligibility requirements
- Meet nursing facility level of care
- Have impairments and unmet needs
- Have Fee-For-Service MO HealthNet coverage (not Managed Care)
Services:
- Assistance with activities of daily living
- Planned group activities
- Food services
- Skilled nursing services
- Transportation
To apply, visit the Online HCBS Referral Form or contact the Department of Health & Senior Services, Division of Senior and Disability Services, using the following contact information:
- Aged & Disabled Waiver (ADW)
Aged & Disabled Waiver (ADW)
The Aged and Disabled Waiver was developed to provide community-based alternatives to individuals aged 65 years and older and individuals with physical disabilities who are ages 63 and 64 who otherwise would be institutionalized in a nursing facility.
Eligibility:
- Meet all general waiver eligibility requirements
- Must meet nursing facility level of care
- Must have impairments and unmet needs
- Allows higher income levels and spousal impoverishment provisions
- Must have Fee-For-Service MO HealthNet coverage (not Managed Care)
Services:
- Homemaker services
- Chore services
- Basic and advanced respite care
- Adult day care
- Home-delivered meals (up to two per day)
To apply, visit the Online HCBS Referral Form or contact the Department of Health & Senior Services, Division of Senior and Disability Services, using the following contact information:
- AIDS Waiver
AIDS Waiver
The AIDS Waiver is designed for MO HealthNet participants 21 years and older living with Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (HIV/AIDS) that, due to their disease, have a decreased level of function and meet nursing home level of care.
Eligibility:
- Meet all general waiver eligibility requirements
- Have HIV/AIDS and currently receiving long-term institutional care or who are at risk of institutionalization.
- Must have Fee-For-Service MO HealthNet coverage (not Managed Care)
- Must meet nursing home level of care and be assessed to meet at least two qualifying conditions.
Services:
- Waiver Personal Care
- Waiver Attendant Care
- Specialized Medical Supplies (limited to diapers, under pads, and gloves)
To apply or find contact information, visit HIV Case Management Regions and Agencies.
- Brain Injury Waiver (BIW)
Brain Injury Waiver (BIW)
The Brain Injury Waiver was developed to provide a community-based alternative for participants 21 to 65 years of age with traumatic brain injuries who otherwise would be institutionalized in a nursing facility. When the participant turns 65 services under the Brain Injury Waiver will be closed and other services will be explored for the participant.
Eligibility:
- Meet all general waiver eligibility requirements
- Must have a documented traumatic brain injury (TBI)
- Must meet nursing facility level of care
- Must have Fee-For-Service MO HealthNet coverage (not Managed Care)
Services:
- Waiver personal care
- Applied behavior analysis
- Assistive technology
- Environmental accessibility and modifications
- Therapy services (occupational, physical, speech, cognitive rehabilitation)
- Neuropsychological evaluation
To apply, visit the Online HCBS Referral Form or contact the Department of Health & Senior Services, Division of Senior and Disability Services, using the following contact information:
- Independent Living Waiver
Independent Living Waiver
The Independent Living Waiver was developed to provide a community-based alternative to individuals 18 through 64 years of age with a cognitive or physical disability who otherwise would be institutionalized in a nursing facility. With this waiver, the participant hires and manages their own service providers.
Eligibility:
- Meet all general waiver eligibility requirements
- Must meet nursing facility level of care
- Have cognitive and/or physical disability (onset after age 22 if cognitive)
- Able to self-direct own services/care
- Capable of living independently with consumer-directed services
- Must allow providers to use Electronic Visit Verification (EVV)
- Must have Fee-For-Service MO HealthNet coverage (not Managed Care)
Services:
- Waiver personal care (self-directed)
- Case management
- Specialized medical equipment and supplies
- Environmental accessibility adaptations
- Financial management services
To apply, visit the Online HCBS Referral Form or contact the Department of Health & Senior Services, Division of Senior and Disability Services, using the following contact information:
- Medically Complex Adult Waiver
Medically Complex Adult Waiver
The Medically Complex Adult Waiver is designed to provide home and community-based services (HCBS) to individuals with serious and complex medical needs, who have reached the age of 21, and who are no longer eligible for home care services available under the Healthy Children and Youth Program. This waiver includes private duty nursing for adults.
Eligibility:
- Meet all general waiver eligibility requirements
- Meet Intermediate Care Facility for Individuals with Intellectual Disabilities level of care
- Previously required PDN through Healthy Children and Youth Program, or had documented need for PDN before age 21
- Must have Fee-For-Service MO HealthNet coverage (not Managed Care)
Services:
- Private duty nursing
- Waiver attendant care
- Specialized medical supplies
To apply, contact the Department of Health & Senior Services, Division of Senior and Disability Services, using the following contact information:
- Structured Family Caregiver Waiver
Structured Family Caregiver Waiver
The Structured Family Caregiver Waiver was developed to provide a community-based option for individuals aged 21 and older diagnosed with Alzheimer's or a dementia-related disorder who otherwise would be institutionalized in a nursing facility.
Eligibility:
- Meet all general waiver eligibility requirements
- Must meet nursing facility level of care
- Have diagnosis of Alzheimer's or dementia-related disorder (by licensed professional)
- Must reside full-time with primary caregiver
- Must establish back-up caregiver plan
- Must have Fee-For-Service MO HealthNet coverage (not Managed Care)
Services:
- Homemaker and attendant care for activities of daily living
- Medication oversight
- Escort to appointments and community activities
To apply, visit the Online HCBS Referral Form or contact the Department of Health & Senior Services, Division of Senior and Disability Services, using the following contact information:
Department of Mental Health Waivers
- Comprehensive Waiver
Comprehensive Waiver
The Comprehensive Waiver provides residential services such as Group Home or Shared Living and Individualized Supported Living to eligible participants of all ages.
Eligibility:
- Meet all general waiver eligibility requirements
- Intellectual disability before age 18 OR developmental disability before age 22
- Substantial functional limitations in three or more major life areas
- Meet Intermediate Care Facility for Individuals with Intellectual Disabilities level of care
- Needs cannot be met through Partnership for Hope or Community Support waivers
- Access based on priority and date of need
Services:
- Day habilitation and community supports
- Personal assistant services (self-directed option available)
- Job development and prevocational services
- Therapy services (occupational, physical, speech)
- Assistive technology and environmental modifications
- Respite care and other community supports
- Residential services (group homes, shared living)
- Individualized supported living
- Intensive therapeutic residential habilitation
For additional information on services, refer to the DDD Waivers Reference Guide. To apply or find contact information, visit the Map of Regional Offices.
- Community Support Waiver
Community Support Waiver
The Community Support Waiver is for individuals of all ages who have a place to live in the community, usually with family.
Eligibility:
- Meet all general waiver eligibility requirements
- Intellectual disability before age 18 OR developmental disability before age 22
- Substantial functional limitations in three or more major life areas
- Meet ICF/IID level of care
- Waiver service needs up to $42,000 per plan year
- Access based on priority and date of need
Services:
- Day habilitation and community supports
- Personal assistant services (self-directed option available)
- Job development and prevocational services
- Therapy services (occupational, physical, speech)
- Assistive technology and environmental modifications
- Respite care and other community supports
For additional information on services, refer to the DDD Waivers Reference Guide. To apply or find contact information, visit the Map of Regional Offices.
- Missouri Children with Developmental Disabilities Waiver (Sarah Lopez Waiver)
Missouri Children with Developmental Disabilities Waiver
The Missouri Children with Developmental Disabilities Waiver is for children (birth through age 17) who live at home with their parents. This waiver allows counting only the child's income (not parent income) for eligibility.
Eligibility:
- Meet all general waiver eligibility requirements
- Intellectual disability before age 18 OR developmental disability before age 18
- Substantial functional limitations in three or more major life areas (per MAAS assessment)
- Meet ICF/IID level of care
- Not eligible for MO HealthNet due to parental income
- Does not reside in residential placement
- Not in custody of Missouri Children's Division
Services:
- Applied behavior analysis
- Day habilitation and skill development
- Community supports and transportation
- Assistive technology and environmental modifications
- Respite care (in-home and out-of-home)
Important Transition Information:
Support coordinators help start transition planning 4 months before the child's 18th birthday. Individuals aging out receive priority status for Community Support Waiver (CSW), Comprehensive Waiver (COMP), or Partnership for Hope (PfH) Waiver.
For additional information on services, refer to the DDD Waivers Reference Guide. To apply or find contact information, visit the Map of Regional Offices.
- Partnership for Hope Waiver (PfH)
Partnership for Hope Waiver
The Partnership for Hope Waiver is a county-based waiver open to all ages. Refer to the Counties with Partnership for Hope Waiver Map.
Eligibility:
- Meet all general waiver eligibility requirements
- Intellectual disability before age 18 OR developmental disability before age 22
- Substantial functional limitations in three or more major life areas
- Meet ICF/IID level of care
- Reside in a county participating in PfH waiver
- Meet county SB40 Board crisis and priority requirements
- Service needs up to $12,362 per plan year (exceptions may be approved)
Services:
- Day habilitation and community supports
- Personal assistant services (self-directed option available)
- Job development and prevocational services
- Therapy services (occupational, physical, speech)
- Assistive technology and environmental modifications
- Respite care and other community supports
- Includes day habilitation, job development, community supports, therapies
- Does not include residential services
For additional information on services, refer to the DDD Waivers Reference Guide. To apply or find contact information, visit the Map of Regional Offices.
Quick Contacts
Department of Health and Senior Services Waivers
HCBSCallCenterReferrals@health.mo.gov
866-835-3505
Department of Mental Health Developmental Disabilities Waivers
Contact your local DMH Regional Office: https://dmh.mo.gov/dev-disabilities/regional-offices