HCBS Memo 06-26-01

Memorandum for Home and Community-Base Services Staff and Stakeholders

DATE: June 30, 2026

FROM: Veronica Jameson, Bureau Chief
Bureau of Policy and Quality Enhancements

SUBJECT: FY 27 Cost Maximum Adjustment, Rate Changes and Service Adjustments

Effective July 1, 2026, the following changes and updates will go into effect:

Cost Maximum:

  • The monthly cost maximum for nursing facility care will increase to $5,593.32. For those limited to 60% of the monthly maximum, the maximum amount will be $3,355.99.

Rates:

  • The Structured Family Caregiving Waiver (SFCW) daily stipend rate has been adjusted to coincide with the new 60% cost maximum. 
  • The and Home Delivered Meals (HDM) reimbursement rate was increased to $10.99 per meal.

Service Adjustments:

  • A new service limitation of forty-nine (49) hours per week was established for Independent Living Waiver (ILW) services and Respite services under the Aged and Disabled Waiver (ADW). This limit applies to all current participants receiving ILW and Basic and Advanced Respite services and will require adjustments to care plans exceeding the new limit.
  • Beginning July 1, 2026, the Division of Senior and Disability Services (DSDS) will contact participants whose care plans exceed the forty-nine (49) hour limit to initiate these changes effective September 1, 2026. Because this requirement is mandated by legislation, it is not considered an adverse action and does not require issuance of an Adverse Action Notice.

The policies outlined below have been updated in the HCBS Policy Manual to reflect these changes.

3.00 Appendix 1 Home and Community Based Services Units and Rates

Updates include:

  • SFCW and HDM reimbursement rate increase
  • Changes to the Agency Model, Consumer Directed Services and RCF/ALF Personal Care units resulting from the cost maximum update
  • Added 868 units/mo to Basic and Advanced Respite and ILW Personal Care Assistance as monthly maximum
3.00 Appendix 2 Home and Community Based Cost Maximums

Updates include:

  • Increase to the 60% cost maximum and the 100% cost maximum
  • Changes to monthly units for Agency Model, RCF/ALF Basic Personal Care and Consumer Directed Services Person Care Assistance resulting from the cost maximum update
  • Added 868 units/mo to Basic and Advanced Respite and ILW Personal Care Assistance as monthly maximum
3.50 Respite Care (ADW)

Updates include:

  • The limit of forty-nine (49) hours per week to be authorized for both Respite and Advanced Respite
  • Formatting changes to include sections for clarity and ease of understanding
3.55 Independent Living Waiver

Updates include:

  • The limit of forty-nine (49) hours per week to be authorized for the ILW
  • Formatting changes for clarity and ease of understanding
4.00 Appendix 3 In-Home Service Worksheet

Updates include:

  • Adjusted the rate for the Home Delivered Meals to ensure accurate calculation
  • Added language limiting Respite to 868 monthly units
4.00 Appendix 4 Consumer Directed Services/Independent Living Waiver Worksheet

Updates include:

  • Separation of CDS and ILW into two (2) separate tabs due to being calculated as separate services
  • Added a formula to highlight the total CDS units in red if the maximum allowable units are exceeded
  • Added a formula to highlight the total ILW units in red if the maximum allowable units are exceeded
4.00 Appendix 4 Consumer Directed Services/Independent Living Waiver Worksheet Instructions

Updates Include:

  • Added language to reflect the completion of ILW due to CDS and ILW being calculated on separate tabs

Questions should be directed to the Bureau of Policy and Quality Enhancements via email at LTSS@health.mo.gov.

Unless otherwise noted, the policy revisions are effective upon receipt.