Home and Community Based Services Manual


3.50 Respite Care (Aged and Disabled Waiver)

Revised - July 2026

Introduction

Respite Care services provide maintenance and supervision to a participant in their home, offering relief to caregivers who typically provide or coordinate daily care. This relief ensures participants continue to receive safe, appropriate supervision and assistance when caregivers are temporarily unable to provide care. By supporting caregiver well-being, Respite helps reduce stress, maintains participant stability, and strengthens the overall caregiving arrangement.

Respite Care is funded through the Aged and Disabled Waiver (ADW) and may be authorized as either Basic or Advanced Respite, depending on the level of support the participant requires.

Eligibility

  • To qualify for Respite, a participant must meet all the following requirements:
  • At least 63 years of age
  • Meet nursing facility level of care
  • Have an appropriate Medicaid Eligibility (ME) Code and be in active Medicaid status
    • Spenddown participants may receive Respite only when their spenddown liability is met.
      • Participants are responsible for costs during unmet spenddown periods.
      • Respite authorization satisfies the requirement for HCB Medicaid eligibility.
  • Participants are eligible for Medicaid through Blind Pension
  • Have a designated caregiver(s) who regularly provides or arranges care
    • Caregivers may include family, friends, or neighbors who provide unpaid support.
  • The Respite aide must be an employee of the HCBS provider and cannot be an immediate family member, defined as a parent, sibling, child or stepchild, spouse, grandparent, or grandchild.

Restrictions

The following are restrictions of Respite, and the participant shall not:

  • Reside in a Nursing Facility, RCF or ALF
  • Receive certain DMH services
  • Be in a Transfer of Property penalty period
  • Participant is receiving services through another HCBS waiver
  • Be a paid caregiver (aide, attendant, home health staff, private pay staff)

Limitations

Respite services are limited to a maximum of 49 hours per week, whether the participant receives Basic Respite, Advanced Respite, or a combination of both.

  • When both types are authorized, the total combined hours still cannot exceed 49 hours in any week.
  • Respite is authorized in 15‑minute units, with a monthly maximum of 868 units.

Process

The Division of Senior and Disability (DSDS) staff determine eligibility, assess the participant’s needs, and create the Person-Centered Care Plan (PCCP). Respite must be provided in the participant’s home and cannot take the place of other services that better meet their needs. Only providers enrolled with Missouri Medicaid Audit and Compliance (MMAC) as ADW providers may deliver Respite, and they must keep their enrollment active.

Respite Care Services

Basic Respite is Intended for participants with non-skilled needs who are unable to perform activities of daily living (ADLs). It is not used when Personal Care or Homemaker services would better address the participant’s ongoing needs.

Advanced Respite is for participants with special care needs requiring a higher level of personal oversight. Participants appropriate for Advanced Respite care include, but are not limited to:

  • Participants who are bedbound and need assistance with positioning, transfer equipment, or elimination
  • Participants who require manual help with non-injectable medication tasks
  • Participants with dementia-related behavior disorders who need close monitoring
    • Examples of such behaviors include appliance misuse, sundowning, wandering or elopement, and delusions or hallucinations.

Respite consists of supportive activities that ensure the participant’s safety, comfort, and essential care needs. Additional HCBS services may be authorized on the same day, but they cannot overlap when Respite is being provided. The following activities include:

  • Supervision
    • Personal oversight of the participant, including making a reasonable effort to assure the safety of the participant and to assist the participant in meeting his/her own essential human needs.
    • Sleeping is permitted when the participant is asleep, provided there is no indication that the participant's condition would pose a risk if the participant awoke while the Respite aide was sleeping.
      • The Respite aide must be near the participant while the participant sleeps.
  • Companionship
    • Provided during the participant's waking hours to make the participant as comfortable as possible. 
  • Direct participant assistance
    • Provided to meet needs usually provided by the regular caregiver.

Cost Maximum

Respite shall be included in the overall cost of care and shall remain within the cost maximum for HCBS unless approval from the Bureau of Federal Programs (BFP) is obtained. When State Plan and ADW services combined exceed the 100% cost maximum, the following steps are required:

  • The appropriate supervisor for DSDS staff shall review all Person-Centered Care Plan (PCCP) requests over the 100% cost cap to ensure the participant’s unmet needs require the amount of service requested
  • If documentation supports the request, the case shall be forwarded to BFP for consideration and approval prior to authorizing
    • Pending the approval from BFP, Respite in combination with other State Plan or ADW services can be authorized up to the 100% of the cost cap.
  • Once approval from BFP is given, the ADW portion of the care plan may be authorized to exceed 100% of the cost cap, while all other State Plan services must remain within their required cost and unit maximums.
  • The cost of one RN visit is excluded from the total cost calculation when RN services are included in the care plan

NOTE: Future increases to ADW services may be approved at the supervisor's discretion without additional BFP review.

Table of Contents