I/DD Waivers in Missouri

All states: Medicaid disability services map

Missouri I/DD services at a glance

Last verified against state sources: 2026-10-23.

Who runs I/DD services in Missouri?

The Missouri Department of Mental Health (DMH), through its Division of Developmental Disabilities (Division of DD, also called DDD), runs I/DD home and community services day to day. It operates the four Medicaid waivers under the Department of Social Services, MO HealthNet Division (MHD), which is the state Medicaid agency and pays the claims. People start at a Division of DD regional office, and support coordinators plan and request each person's services.

• Division of DD (Department of Mental Health): determines DD eligibility, runs intake through its regional offices, prior-authorizes waiver services and contracts with providers. It also runs state-operated habilitation centers.
• MO HealthNet Division (Department of Social Services): the Medicaid agency. Providers bill MHD for waiver services after the Division of DD authorizes them. The Family Support Division, also part of the Department of Social Services, decides Medicaid financial eligibility.
• State match: the Division of DD uses state general revenue and local county dollars as the state share of waiver costs.
• Front door: anyone can refer a person to the Division of DD Regional Office that serves their county, or use the Division's online referral form, as described on DMH's how to get services page.
• Case management: Targeted Case Management (TCM) for people with developmental disabilities is an optional Medicaid state plan service. Support coordinators work for Division of DD regional offices or for approved TCM entities under contract with the Division, including county Senate Bill 40 (SB 40) boards and not-for-profit agencies. They evaluate level of care, lead person-centered planning and request service authorizations, which the regional office approves.

What Medicaid waivers and programs serve people with I/DD in Missouri?

Missouri has four 1915(c) waivers for people with intellectual and developmental disabilities. A 1915(c) waiver is a federal Medicaid option that lets a state pay for home and community services instead of institutional care. All four require the person to be eligible for MO HealthNet (Missouri Medicaid) and to need the level of care given in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID). Only the Comprehensive Waiver pays for residential services.

• Comprehensive Waiver (1915(c)): serves people of all ages who need residential services and whose needs cannot be met through Partnership for Hope or Community Support. It is the only DD waiver with group homes, shared living, Individualized Supported Living (ISL) and Intensive Therapeutic Residential Habilitation. It also covers day habilitation, personal assistant, skill development, community networking, employment services, respite, remote supports, behavior and therapy services, and support brokers.
• Community Support Waiver (CSW, 1915(c)): serves people of all ages who have a place to live in the community, usually with family, and whose needs fit within a $42,000 annual cost limit (exceptions are possible). It covers personal assistant, day habilitation, skill development, community networking, employment services, respite, home delivered meals, remote supports, behavior and therapy services, and support brokers. It also covers the services of the former Autism Waiver, which expired June 30, 2017.
• Partnership for Hope Waiver (PfH, 1915(c)): a county-based partnership of the Missouri Association of County Developmental Disabilities Services, the Division of DD and MHD. It serves people of all ages who live in a participating county, do not need residential services and typically live with family. The annual cost limit is $12,362, or up to $15,000 when criteria are met, with limited exceptions. Services include personal assistant, day habilitation, skill development, community networking, employment services, temporary residential, dental, family peer support, remote supports and support brokers.
• Missouri Children with Developmental Disabilities Waiver (MOCDD, also called the Sarah Jian Lopez Waiver, 1915(c)): serves children from birth through age 17 who live at home with their parents and are not eligible for MO HealthNet for Kids or CHIP because of parental income. Only the child's income counts. It does not serve children in residential placement or Children's Division custody. Services include personal assistant, day habilitation, skill development, community networking, respite, applied behavior analysis, crisis intervention, home modifications, assistive technology and specialized medical equipment. Transition planning starts four months before age 18, and young adults aging out get priority for the other three waivers.

We did not find the waivers' CMS control numbers on a state page that loaded. Missouri also offers DD Targeted Case Management as a state plan service and has a DD Health Home. ICF/IID care, including DMH's state-operated habilitation centers such as Bellefontaine, Higginsville and the St. Louis DD Treatment Center sites, is the institutional option that the waivers are an alternative to.

Does Missouri pay for I/DD services through managed care?

No managed care plan role in DD waiver services was found. Missouri pays for DD waiver services fee-for-service through MO HealthNet. The Division of DD regional office prior-authorizes each service in its automated authorization and billing system, and the provider then bills MHD.

• Who authorizes: the Division of DD regional office, based on the person-centered plan the support coordinator builds.
• Who pays claims: the MO HealthNet Division, at the rates DMH sets.
• Who coordinates services: support coordinators at regional offices or contracted TCM entities, not a health plan.
• Organized Health Care Delivery System (OHCDS): a provider may bill through an OHCDS, an organization that subcontracts with other qualified providers. A qualified provider cannot be forced to contract with an OHCDS and may enroll directly with MHD, according to the DD Waiver Manual.

We did not find a state page that says in so many words that DD waiver services are carved out of MO HealthNet managed care. Providers who need that confirmed should ask MHD or the Division of DD.

Is there a waiting list for I/DD services in Missouri?

Yes. Missouri limits waiver slots to the funding in the state budget and does not publish a count of people waiting. Since October 15, 2026, new enrollments into the Comprehensive, Community Support and Partnership for Hope waivers go on a wait list because of budget limits, with no estimated end date. People are served by priority of need and then by the date they were added.

• Who still gets in: new participants funded through inter-divisional agreements, or whose participation is required by federal rule, still have access to waiver services.
• Priority order: under state rule 9 CSR 45-2.015, people are ranked by priority of need (PON) from 1 to 5. PON 1 to 4 come from the MAAS score, and PON 5 is for verified crisis criteria. Within a priority level, the person added first is served first, subject to the slots and funding in the state budget, as explained on DMH's waiting list page.
• Partnership for Hope: the county SB 40 board sorts applicants into Crisis and Priority categories, and the longest-waiting person is served first within each category.
• MOCDD (Lopez) Waiver: the memo names the other three waivers. We did not confirm whether the children's waiver is affected.
• Count: DMH names a Monthly DDD HCBS Wait List Report and a Waiver Processing List, but we did not find a published copy or count.

For a person's place on the list, families can ask their Division of DD Regional Office or support coordinator.

How do people apply for I/DD services in Missouri, and how are budgets set?

Anyone can refer a person to the Division of DD Regional Office for their county or through the Division's online referral form. The Intake Unit contacts the person within one business day and mails an application packet. The Division then verifies the disability from records and uses the Missouri Adaptive Ability Scale (MAAS) to confirm functional limits, set priority of need and score the person's rate allocation.

• DD eligibility: the Division of DD verifies an intellectual disability that began before age 18 or a developmental disability that began before age 22, using medical, psychological and school records. The person must have substantial limits in three or more major life areas.
• Waiver eligibility: the person must also be eligible for MO HealthNet (decided by the Family Support Division, except for MOCDD, which counts only the child's income), need ICF/IID level of care and meet the waiver's own criteria.
• Notice and appeals: written notice of the eligibility decision follows within three business days, with appeal rights.
• Assessment: the MAAS confirms functional limits and produces both the priority of need (PON) and the rate allocation score (RAS). The Division completes the MAAS if there is no valid adaptive assessment from the past three years.
• Budgets and limits: the support coordinator builds a person-centered plan and requests services, and the regional office approves them. Annual cost limits are $42,000 for the Community Support Waiver and $12,362 (up to $15,000) for Partnership for Hope.

What day and residential services can I/DD providers offer in Missouri?

Missouri DD waiver providers can offer day habilitation, community networking, individualized skill development and several employment services, most billed in 15-minute units. Residential services (group homes, ISL, shared living and intensive therapeutic residential habilitation) are available only in the Comprehensive Waiver and are paid per day. Most services require a DMH contract plus Division of DD certification under 9 CSR 45-5.010, or accreditation by CARF, CQL or the Joint Commission.

Day and employment services

• Day Habilitation (all four waivers): regularly scheduled skill-building in self-help, socialization and daily living, including supported retirement, partly at a certified facility and regularly in the community. It is not vocational. Group size is no larger than 6. Billed in 15-minute units (T2021 HQ), up to 32 units (8 hours) a day, with medical (T2021 SC) and behavioral (T2021 TG) exception rates for people with higher needs.
• Community Networking (all four waivers, formerly Community Integration): support to take part in integrated community activities, with paid support expected to fade toward natural supports. Groups have no more than 4 people per staff person. Billed in 15-minute units (T2021 SE individual, T2021 HQ SE group), up to 432 units (108 hours) a month. Not available to people in group homes, ISL or shared living.
• Individualized Skill Development (all four waivers): teaching of complex skills such as budgeting, home management or using public transportation, for people living in their own or family homes. Groups have no more than 4 people. Billed in 15-minute units.
• Prevocational services (Comprehensive, Community Support and Partnership for Hope): time-limited learning of general work skills aimed at competitive integrated employment, never in the person's home. Small groups have no more than 4 people. Billed in 15-minute units (H2025 individual, H2025 HQ group), up to 32 units a day and 2,080 units a plan year.
• Supported employment, career planning and job development (Comprehensive, Community Support and Partnership for Hope): help to get and keep competitive integrated work, including individual supported employment and small-group work such as business-based work groups or mobile crews. Billed in 15-minute units (H2023 individual up to 48 units a day, H2023 HQ group up to 32 units a day). We did not find a published staff ratio.

Employment services agencies must be certified by DMH or accredited by CARF, CQL or the Joint Commission and hold a DMH contract.

Residential services (Comprehensive Waiver only)

• Group Home: care, supervision and skills training in group homes, residential care centers and semi-independent living (clustered apartments). Paid per day (T2016 HQ), with intensive and transition variants, and room and board excluded. Staffing follows three categories: Category I is 1:8 day and evening and 1:16 at night, Category II is 1:4 and 1:8, and Category III is 1:3 and 1:6. Nursing oversight is authorized separately.
• Individualized Supported Living (ISL): individually planned supports, up to 24 hours a day, in a home the person chooses, with no more than four ISL recipients sharing a residence. Billed per day (T2016) with mileage codes for transportation. Immediate family cannot be paid.
• Shared Living (host home and companion home): the person lives with a family, couple or individual, either in the caregiver's home (host home) or the person's own home (companion home). A home may serve up to three people. Paid per day (S5136) at a rate tied to intensity and difficulty of care. Parents of minors, guardians and spouses cannot be providers. Individuals or agencies need a DMH contract and Division of DD certification under 9 CSR 45-5.010 to .060, or accreditation.
• Intensive Therapeutic Residential Habilitation (ITRH): a clinical residential model with an integrated treatment team, meant to prepare the person to move back to a less restrictive community setting. Billed per day (T2016 HK). We did not find the certification requirements specific to ITRH.

Day habilitation, group home, ISL, personal assistant, shared living, out-of-home respite and employment services all require Degreed Professional Management, meaning a manager with a bachelor's degree or substitute experience.

How are I/DD provider rates set and how do agencies enroll in Missouri?

DMH sets DD waiver rates, informed by published rate studies, and providers bill MHD at the authorized rate after Division of DD prior authorization. Group homes and ISL are paid per day, shared living has a daily rate tied to intensity and difficulty of care, and most other services use 15-minute units. Agencies enroll by getting a DMH contract plus Division of DD certification or national accreditation.

• Rate studies: DMH's waiver page lists a 2018 residential rate study, a 2022 HCBS rate study, targeted case management and self-directed supports rate studies, and an ISL standardized rate phase-in plan.
• Latest rate activity: DMH posted a Day Habilitation Rate Study stakeholder meeting presentation dated September 2, 2026. No resulting rate change has been announced, and we did not find a fiscal year 2027 DD rate notice.
• Incentive payments: DMH adds value based payments for EVV use by agency personal assistant providers (1 percent of paid personal assistant claims each six months when at least 80 percent of visits reach the state aggregator with all data points), $55 per complete quarterly employment outcome report, and $1,560 when a newly hired direct support professional reaches 50 percent of the Missouri Talent Pathways Certified DSP Registered Apprenticeship.
• Enrollment: most waiver services need a DMH contract plus certification under 9 CSR 45-5.010 or accreditation by CARF, CQL or the Joint Commission. DMH posts its new provider enrollment directive, an enrollment FAQ and a guide to the process on its Information for Service Providers page. Provider questions go to DDProviderRelations@dmh.mo.gov.
• EVV: Personal Assistant services in the DD waivers, both agency and self-directed, must be captured in an EVV system that reports to the state's Sandata aggregator, as MHD explains in its EVV hot tip for DMH waiver providers. The current DD Waiver Manual names only personal assistant services in its EVV language. We did not find a current state source on whether group home, ISL or shared living fall outside EVV.

What is changing next for I/DD services in Missouri?

The biggest recent change is the wait list: since October 15, 2026, new enrollment in the Comprehensive, Community Support and Partnership for Hope waivers goes on a wait list. Two waiver renewals are also pending. The state has not published a final approval or effective date for them, so treat the items below as in progress.

• Waiver renewals and amendments: the Department of Social Services posted a public notice on February 6, 2026 for renewals of the Comprehensive and Community Support waivers and amendments to the Partnership for Hope and MOCDD waivers. We could not read the draft documents. On June 30, 2026, DMH issued DD Provider Bulletin No. 4, Temporary Extension for Waiver Renewals, which suggests the renewals were extended while approval is pending. We did not find what the extension covers or when the renewed waivers take effect.
• EVV claim denials: a DMH provider bulletin from July 2026 said claims without matching EVV records would start being denied for provider type 85 in a third phase of claims validation. A later MHD notice called the planned date tentative, and we did not find a notice confirming the start or a delay as of October 22, 2026. The Division of DD was still holding EVV office hours for Personal Assistant providers in late October 2026.
• Day habilitation rates: a day habilitation rate study is under way, with a stakeholder presentation dated September 2, 2026. No rate change from it has been announced.

For the latest, check the Division of DD's weekly newsletter and provider bulletins, or ask DDProviderRelations@dmh.mo.gov.

Missouri I/DD sources

• Missouri DMH Division of DD: Home and Community Based Medicaid Waivers
• Missouri DMH Division of DD: Wait list memo (October 15, 2026)
• Missouri DMH Division of DD: Waiting list
• Missouri Department of Social Services: DD Waiver Manual (September 2026)
• MO HealthNet: Waiver programs information for participants
• Missouri DMH Division of DD: How to get services
• Missouri DMH Division of DD: Targeted case management
• Missouri DMH Division of DD: Information for service providers
• Missouri Department of Social Services: Public notice of DD waiver renewals and amendments (February 6, 2026)
• MO HealthNet: EVV hot tip for Department of Mental Health waiver providers

Related reading

• Disability Services and Independent Living Guide
• Developmental Disabilities vs. Mental Health: Key Differences
• Essential Acronyms in Disability Services: A Quick Reference Guide
• Disability Services DayHab has a dilemma - how to solve it
• I/DD services in every state (map)
• Missouri EVV requirements

Page history

• October 23, 2026: Page rewritten and checked against state sources.

This page is a reference, not legal advice. State rules change, so confirm details with the state before you act on them.

Ankota provides software for I/DD provider agencies, including EVV, service documentation, goal tracking and billing. If you would like to talk through your program, contact Ankota or read more about Ankota's I/DD software.