Updated September 3, 2026. Quick answer: partially, through Consumer Directed Services (CDS), Personal Care Assistance, State Plan (Consumer-Directed Service Model), where family pay is possible but narrower than a full open hire. A spouse cannot be the paid caregiver; the federal rule against paying a “legally responsible relative” still applies here.
How Missouri pays a family caregiver
| Program | Consumer Directed Services (CDS), Personal Care Assistance, State Plan (Consumer-Directed Service Model) |
|---|---|
| Can a family member be paid? | Partial. “Only legally responsible individuals (court appointed guardian or conservator) and spouses are prohibited from being an attendant in the CDS program.” |
| Can a spouse be paid? | No. “Missouri recognizes same sex marriages; spouses cannot be the paid CDS attendant.” |
Why the spouse question is different
Federal Medicaid rule treats a spouse (and a parent paying for a minor child) as a “legally responsible relative”, someone already assumed to owe the care for free, so paying them is barred by default. A state has to build an explicit exception into its waiver or state-plan option to pay a spouse at all; the rule for any other relative (an adult child, a sibling, a grandchild) is looser and usually allowed. That is why the two rows above can carry different answers on the same page.
The going rate
$5.23 per 15-minute unit (≈$20.92/hour) Medicaid reimbursement rate. “Personal Care Assistance – Consumer Directed Model | T1019U2 | 15 min. | 603 units/mo | $5.23”
How it works
The participant applies for the Consumer-Directed Model of Personal Care Assistance through DHSS/DSDS; the participant selects a CDS agency enrolled with DSS’s MMAC Unit, which acts as the financial management service and pays the individual (who can be a family member other than a spouse or court-appointed guardian/conservator) the participant hires, trains, and supervises.
What this doesn’t answer
The $5.23/15-min figure is the Medicaid billing/reimbursement rate paid to the FMS agency, not a confirmed net hourly wage the family attendant actually receives after any administrative deduction or payroll taxes. Application timelines and waitlist status were not found on an official page this session.
Sources
- MO DHSS HCBS Manual: Consumer Directed Services policy clarification
- MO DHSS HCBS Manual: 3.00 Appendix 1, Services Units and Rates (CDS rate T1019U2 $5.23/15-min)
- MMAC/DSS: Consumer Directed Services General Information
Read September 3, 2026.
Same question, other states: Montana · Alaska.
Related: the private-pay caregiver-agreement rule · the household-employee tax rules once you’re being paid · what family caregiving actually costs unpaid.
General information drawn from each state’s own Medicaid agency and public program materials, not legal, tax or financial advice. Medicaid self-direction programs are administered state by state and change by budget cycle and waiver renewal; this page cannot see your own state’s current program status or your family’s eligibility. We are not a law firm, a benefits counselor, or a fiduciary, and this is not personalized advice. We sell nothing on this page and earn nothing from it.