When Medicaid in Missouri Will Pay for a Nursing Home, Assisted Living, or Home Health Care

With the average monthly cost of a private room in a nursing home in Missouri over $6,500 in 2024, seniors likely to need long-term care should pay serious attention to ensure they have a way to pay for that care.

Long-term care (LTC) is usually paid for by savings, nursing home insurance, or Medicaid. If you can't afford to pay privately and don't have LTC insurance, Missouri's Medicaid program (MO HealthNet) might pay for your care.

Medicaid is a medical assistance program funded by the federal and state governments to pay for, among other things, long-term care for people who are over 65, disabled, or blind. Other types of Medicaid services have different eligibility guidelines than the rules for LTC.

MO HealthNet, administered by the state's Department of Social Services (DSS) agency, covers the cost of long-term care for eligible beneficiaries, including:

• skilled nursing facilities
• intermediate care facilities, and
• hospital stays lasting 30 days or more.

If MO HealthNet determines you need this level of care, you might qualify for Medicaid benefits. But you must meet certain income and resource requirements.

Missouri also operates certain Medicaid waiver plans, known as home and community-based service (HCBS) waivers, that include programs that allow seniors and individuals with disabilities in need of assistance to remain living independently, in their homes and communities, instead of in a nursing home.

Medicaid Coverage for Nursing Homes in Missouri

If you're 65 or older, blind, or disabled and meet income and resource requirements, MO HealthNet provides coverage for nursing home residents under certain circumstances.

To get coverage for nursing home care, you must be financially eligible and need the kind of care nursing homes provide. That could include:

• 24-hour supervised nursing care
• personal care
• therapy, and
• nutrition management.

Before you apply for Medicaid coverage, make sure you meet the eligibility criteria. Typically, your nursing home or residential care facility can assist you with the Medicaid application process.

For more information, visit MO HealthNet online. You can get answers about your case or ask general questions by contacting the Missouri DSS Family Services Division (FSD) in one of the following ways:

• call FSD at 855-373-4636
• contact your local FSD resource center
• send email to [email protected], or
• chat with a representative online at mydss.mo.gov (select "DSS Chat").

Representatives are available Monday–Friday from 8 a.m. to 5 p.m. You can also apply for MO HealthNet online.

Medicaid Income Rules in Missouri

In Missouri, to qualify for Medicaid-paid nursing home care, known as "vendor coverage," all of a single applicant's income must go towards the cost of care. If you're eligible, MO HealthNet will pay the cost of skilled nursing or intermediate care that your income doesn't cover.

Note that Missouri's Medicaid nursing home income rules differ from the income limits for those applying for other health care benefits from Medicaid. For example, applicants for certain HCBS Medicaid waiver programs, discussed below, must have income under the 2025 monthly income limit of $1,690.

For determining Medicaid LTC eligibility, any income an applicant receives from any source is considered. But when only one spouse of a married couple applies for Medicaid, the state doesn't count the income of the non-applicant spouse so that the spouse has enough funds to live on. Additionally, if the non-applicant spouse doesn't have enough assets in their own name, they can keep a minimum monthly needs allowance, which can range from $2,555 to $3,984 (the higher limit is for spouses with high housing or utility costs).

If you qualify for Medicaid and live in a nursing home, you'll be expected to spend almost all your income on your care. MO HealthNet allows nursing home residents receiving Medicaid to keep only $50 per month as a personal needs allowance.

Medicaid Asset Rules in Missouri

Missouri has different resource rules for Medicaid for LTC—which you must satisfy to be eligible for coverage—than for other MO HealthNet programs. To determine how much you have in resources, you'll have to total up the value of all your assets. For eligibility purposes, resources are assets and include things like:

• real property
• personal property
• life insurance with a cash value
• vehicles
• motorhomes
• boats
• IRAs
• bank accounts, and
• cash.

If you're a single person, you can have only up to $5,909 in assets with a few allowable exclusions, such as a car and your home (up to a value of $730,000 in 2025). But if you're married, your non-applicant spouse at home can keep 50% of your joint assets, up to $157,920—that's in addition to your $5,909. If your spouse is also applying for MO HealthNet LTC benefits, your combined assets can't be more than $11,818.

Missouri Medicaid HCBS Waiver Programs, Assisted Living, and Home Care Options

Some Missouri Medicaid recipients get LTC services delivered outside of the nursing home facility setting. These home and community-based service programs have different eligibility requirements and offer benefits designed to provide seniors and people with disabilities with the services they need to live in the least restrictive environment possible.

MO HealthNet HCBS Entitlement and Waiver Programs

MO HealthNet provides home and community-based services (HCBS) through the state's regular Medicaid plan and Medicaid waivers. State plan HCBS programs are entitlements—meaning every Medicaid recipient who meets program eligibility requirements will receive the benefit.

Missouri operates several Medicaid HCBS waiver programs designed to provide assistance so you can live independently—in your home or community—instead of in a nursing home. But HCBS waiver programs aren't entitlements, so they're only available to a limited number of participants. Once the limit is reached, a waitlist for benefits forms.

Medicaid waivers allow MO HealthNet to offer services targeted to specific populations. For instance, the Structured Family Caregiving Waiver provides home and community-based services only for those diagnosed with Alzheimer's or a related disorder who need nursing home-level care.

Missouri Care Options (MCO) for Seniors

Through the Missouri Care Options (MCO) program, MO HealthNet offers long-term care services to Medicaid-eligible state residents who require nursing home-level care but who don't want to live in a nursing home. MCO provides home or community-based assistance, like:

• help with personal care activities, like bathing and dressing
• respite care (to give your family caregivers a break)
• housekeeping and laundry services
• shopping and meal preparation
• nursing care, and
• supervised adult daycare programs.

Because MCO is an entitlement, all eligible Medicaid recipients can receive LTC services through the program.

Missouri's Aged and Disabled Waiver (ADW) Program

MO HealthNet's Aged and Disabled Waiver (ADW) program offers assistance on a limited-availability basis. The ADW program offers in-home services to eligible individuals 63 and older who would require nursing home care if they didn't receive assistance. ADW provides help with daily tasks like:

• household chores
• homemaking
• respite care, and
• preparing meals.

ADW program participants can also access adult daycare, enabling their families to work outside the home while still providing their care.

MO HealthNet's Consumer Directed Services (CDS) Program

MO HealthNet also offers a Personal Care Assistance Consumer Directed Services (CDS) program, or self-directed care, through which eligible applicants can hire, train, and supervise care providers who assist them at home. CDS is also available to Medicaid recipients who live in residential care or assisted living facilities.

But the CDS program provides only personal care assistance—help with certain activities of daily living—not medical care. This entitlement program allows any eligible Medicaid recipient to hire a friend or family member (except a spouse) as a personal care provider paid by the state.

Missouri's Independent Living Waiver

The Independent Living Waiver (ILW) program is similar to CDS, requiring that applicants meet the same eligibility criteria. But it offers eligible recipients services not covered by CDS, such as:

• environmental accessibility adaptations
• specialized medical equipment and supplies
• financial management services, and
• case management.

But, because ILW is a waiver program, the number of participants is limited.

Supplemental Nursing Care (SNC) Financial Assistance Program

Another MO HealthNet entitlement program, the Supplemental Nursing Care (SNC) financial assistance program, provides a cash benefit to help eligible individuals pay for residential care. Program participants receive payments in varying amounts, depending on whether they live in an assisted living facility or a residential care facility.

While the state doesn't limit the number of Medicaid recipients who can take part in the SNC program, you could face a waitlist for an open bed at a specific residential care or assisted living facility.

Learn More About Missouri's LTC Entitlement and Waiver Programs

MO HealthNet, Missouri's Department of Social Services (DSS), and the Missouri Department of Health and Senior Services (DHSS) offer many programs aimed at helping seniors and people with disabilities live as independently as possible. You can learn more about Missouri independent living options by:

• visiting DHSS online
• calling DHSS at 573-751-6400, or
• sending email to: [email protected].

For general information about MO HealthNet waiver programs, visit the Missouri DSS website. Learn more about the SNC program, including eligibility requirements, by contacting your county Family Support Division (FSD):

• call the FSD information center at 855-373-4636
• text general questions (not case-specific) to 855-684-9242, or
• visit the Missouri Department of Social Services contact information page.

Learn more about other services available to seniors in your area by contacting your local Area Agency on Aging (AAA) or by calling the Missouri Seniors Resource Line at 800-235-5503 (enter your zip code to be connected to your local AAA office).