JEFFERSON CITY — In the next year, people with disabilities receiving in-home care through Medicaid could see that service whittled down.

A proposed budget bill would shrink the funding for such care, known as Consumer Directed Service, by 7.5%, a change which advocates say would severely impact the program. Gov. Mike Parson’s recommendation, which has been adopted into the budget proposal being considered by the Missouri House of Representatives, includes two cuts to the program which total about $12.5 million in general revenue funds.

In Missouri, CDS provides care to about 40,000 Medicaid enrollees.

“Consumer Directed Services allows people with disabilities to hire caregivers to come into their home and provide personal care services,” said Jessica Macy, executive director of Services for Independent Living. “That includes things like helping them get out of bed in the morning, get showered, do meal preparation, do laundry, run errands — things that can really challenge somebody with a disability, depending on their physical disability — and allows them to live independently and stay out of a nursing home.”

Advocates for the program stated that, because of COVID-19 and its impact on nursing homes, these services are more important than ever.

“The proposed cuts are coming at a time during the pandemic when health care is of the utmost importance, and at a time when the state is seeing unprecedented funds streaming into the state for the very purpose of helping Missourians remain safe and healthy in their own homes,” said representatives for Services for Independent Living and Independent Living Resource Center in a news release.

Macy told the Missourian that one lawmaker has already pledged to try and get the cuts restored when the House Budget Committee meets Thursday.

Melinda Cardonne, executive director of ILRC, said that in her 15 years working with the organization she’s seen the program make a huge difference for participants.

“We’ve helped people move out of nursing homes, into their own home and then be able to go to work,” said Cardonne. ”We’ve got a young lady who has been receiving services through ILRC for several years now. We’ve seen her go to college at MU, where she has gotten her master’s degree in social work. She works for Department of Mental Health currently, and she’s going back to school to get her PhD. For her, without the services, she wouldn’t have been able to do that.”

Without the necessary funds, Macy said, they wouldn’t be able to continue to pay to provide these services.

“The two cuts that the governor has proposed are to the reimbursement that the providers receive,” said Macy. “That reimbursement is what we use to pay the attendants, to pay the taxes and to do all of the oversight. And so it will affect everything.”

The governor’s budget cites a 2019 Mercer Home and Community Based Services study as a reason for the cuts. The study was done nationally by the consultants to recommend funding for services like CDS. In line with the study’s findings, the funds would be reallocated to increase money that goes to private duty nursing providers and other non-CDS providers.

The Missourian was unable to reach anyone in the state Office of Administration to discuss the proposed cut Wednesday.

The problem with using the recommendations of the study, according to CDS advocates, is that the CDS program in Missouri includes extra costs that don’t apply to other states’ programs and the study failed to account for Missouri’s rising minimum wage.

”Once we do all of the requirements, with these cuts that they are proposing, we’re going to be losing money,” said Cardonne. “There’s no profit for a provider to do this service, and businesses can’t run without making any money, let alone losing money.”

  • Public Life reporter, fall 2020. Studying investigative journalism. Reach me at, or in the newsroom at 882-5720

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