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Consumer Directed Services

Consumer Directed Services (CDS) is a Medicaid-based program that provides personal care attendant (PCA) services to individuals with disabilities, enabling them to live independently.

Participants in the CDS program are trained to hire attendants to assist them with tasks of daily living. The tasks may include bathing/showering, toileting, obtaining medication, meal preparation and cleanup, housekeeping/laundry and essential transportation.

The CDS program is designed to assist people with disabilities with receiving the attendant services needed to safely live in a home setting of their choice instead of living in a more restrictive institutional environment.

Gateway's CDS program is consumer controlled. A main component of consumer control is that the person who receives CDS is the employer of the attendant. CDS program participants are responsible for locating, hiring, setting work schedules and managing attendants. A qualified friend or family member may be hired as an attendant with the exception of a spouse or anyone under the age of 18.


Can I receive CDS where I live?

Gateway primarily serves CDS program participants in the city of St. Louis and St. Louis County, however, several participants live in Franklin County, Jefferson County and St. Charles County. If you live outside of Gateway’s primary service area, you are still able to receive CDS though a Center for Independent Living or another approved agency.

What types of services can I received through CDS?

CDS provides people with disabilities with assistance in the following areas. Participants may qualify for some or all of these services.

  • Bathing

  • Dressing

  • Grooming

  • Toileting

  • Ostomy/colostomy hygiene

  • Obtaining medication

  • Transferring

  • Range of motion

  • Meal preparation/feeding/cleanup

  • Housekeeping/laundry

  • Errand transportation (shopping, paying bills/banking, picking up medication)

  • Medical transportation (limited)

You will also receive personalized attention from your CDS specialist, who will assist you with your independent living goals and offer resources to help you meet your needs and expand your knowledge.

What are the qualifications to receive CDS?

A CDS program participant must:

  • Be eligible for MO HealthNet (Medicaid).

  • Be 18 years of age or older.

  • Be able to direct his or her own care.

  • Be physically disabled.

  • Be capable of living independently with the services of a personal care attendant.

  • Require at least a nursing facility level of care.

The Missouri Department of Health and Senior Services (DHSS) (or its designee) will assess people who meet the minimum qualifications to see if they are eligible for the CDS program. If a person is eligible, DHSS and the potential participant will create a care plan that outlines the type(s) of service(s) the person will be approved to receive from a personal care attendant through the CDS program.

How can I become a CDS participant through Gateway?

If you meet the minimum qualifications, please visit our Get Services page or call (314) 289-4200. An intake specialist will complete a preliminary screening and refer you to DHSS for an assessment. Someone from our attendant services department will then help you get your personal care attendant prepared for employment.

Who can become a personal care attendant?

CDS program participants can hire up to four personal care attendants. An attendant can be any qualified caregiver chosen by the CDS program participant, including a family member (other than a spouse).

A CDS program participant is the legal employer of his or her personal care attendant. Participants are responsible for interviewing, hiring, scheduling, directing and, if necessary, firing an attendant. Personal care attendants do not work for Gateway.

Personal care attendants must pass a background check through the Family Care Safety Registry (FCSR) and the Employee Disqualification List. Attendants must also complete an employee eligibility check using E-Verify through the U.S. Department of Homeland Security. Gateway completes all required background checks.

If requested, Gateway will provide support and assistance and training to a CDS program participant.

What does a personal care attendant need to do to begin working?

All perspective personal care attendants must visit Gateway prior to being employed by a CDS program participant. When an attendant visits, he or she must present:

  • a current, original state-issued photo ID.

  • an original Social Security card.

  • cash or a money order for $14.25 (one-time fee) to cover FCSR registration costs.

If an attendant is already listed on the FCSR, please bring only a current, original state-issued photo ID and original Social Security card.

When can a personal care attendant begin working?

A personal care attendant cannot begin working for a CDS program participant until the participant has been assessed by DHSS and approved to receive service(s). A participant must also be trained by Gateway to become a legal employer. The participant will then receive time sheets from from Gateway and will be given a start date for an attendant to begin working.

Who pays a personal care attendant?

The CDS program is funded by MO HealthNet (Medicaid). Participants who receive Medicare or have private insurance are not eligible for the CDS program.

A participant must be eligible to receive MO HealthNet (Medicaid) in order for a personal care attendant to be paid.

Verified and approved attendant services are billed to MO HealthNet (Medicaid) in accordance with the care plan authorized by DHSS.

The attendant is paid by money received from a participant’s MO HealthNet (Medicaid) account for authorized care plan service(s) provided to the participant.

How much is a personal care attendant paid?

As of May 28, 2016, personal care attendants are paid at a rate of $12an hour.

To learn more, please call us at 314.289.4200 or click here to submit a request for information on services.


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