HCBS Referrals, Requests & Eligibility Determination

HCBS Referrals and Care Plan Change Request

The Division of Senior and Disability Services (DSDS) is responsible for administering Home and Community-Based Services (HCBS), including the intake of referrals, assessment of nursing facility level of care (LOC) and authorization of services through person-centered care planning. Providers may assist individuals with making a new referral for HCBS services or in need of a care plan change.

Providers should use the online options below when submitting a request or referral. Participants, family, friends, or informal supports may also submit by phone at 866-835-3505. The phone line is reserved for participants and their supports only. This is an effort to ensure accessibility to participants, who may not have other means to contact DSDS.

Referral Graphic

Make an Initial Referral

The online HCBS Referral form is the first point of contact for individuals newly seeking assistance through the HCBS program.

This form is for individuals who are NOT currently authorized for HCBS.

Paper referrals may also be sent using the HCBS Referral Form (HCBS-1) to HCBSCallCenterReferrals@health.mo.gov.

Providers should share the referral preparation materials with the participant if making a referral on their behalf.  Brochure Version / Online Version

Referral Graphic

Request a Care Plan Change

The online care plan request form is used to request an adjustment to the existing person-centered care plan (PCCP)

This form is used for Participants who are currently authorized for HCBS.

Providers should share the care plan preparation materials with the participant if making a request on their behalf. Brochure Version / Online Version

Eligibility Determination

HCBS is available to seniors and individuals with disabilities who meet specific eligibility requirements, including, but not limited to:

  • Determined eligible or potentially eligible for Medicaid benefits that reimburse for HCBS.
  • Agreeable to participate in a face-to-face assessment, sign the participant choice statement and develop a person-centered care plan (PCCP).
  • Determined to meet nursing facility Level of Care (LOC).
    • DSDS uses the InterRAI HC tool for assessments. Algorithms in the electronic case record system assign a LOC score. A score of 18 or higher qualifies for LOC and HCBS; otherwise, they are ineligible.
    • The same LOC eligibility criteria required to enter a nursing facility, as outlined in 19 CSR 30-81, is used to qualify for HCBS.
    • The following resources provide in-depth details related to the qualifying criteria:
  • Assessed to have an unmet need(s) which can be met through the authorization of HCBS.