CDS vs In-Home Services in Missouri: Which One Is Right for Your Business?

Consumer Directed Services (CDS) allows eligible individuals — called participants — to hire and manage their own attendants with the support of a CDS agency.

In this model:

• The participant is the employer, not the agency.

• The CDS agency acts as a fiscal intermediary, handling payroll, taxes, background checks, and training oversight.

• Attendants are usually family members or trusted friends chosen by the participant.

CDS Agency Responsibilities Include:

• Ensuring participants meet MO HealthNet eligibility

• Verifying attendant qualifications and training

• Processing payroll and timesheets

• Submitting billing to MO HealthNet

• Maintaining participant and attendant files for audits

The CDS model gives clients more independence while allowing your business to operate with lower overhead, since you don’t directly employ or supervise aides.

What Are In-Home Services (IHS)?

In-Home Services (IHS) agencies, on the other hand, hire and supervise their own employees who provide personal care, homemaker, and advanced personal care (APC) services directly to clients.

IHS Agency Responsibilities Include:

• Hiring, training, and supervising aides

• Ensuring all employees complete initial and advanced training

• Maintaining RN oversight and client care plans

• Implementing Electronic Visit Verification (EVV)

• Submitting claims and maintaining compliance with 13 CSR 70-91.010

This model offers greater control over quality and operations, but it also comes with more regulatory requirements, higher startup costs, and ongoing supervision responsibilities.

Key Differences Between CDS and In-Home Services

Feature	Consumer Directed Services (CDS)	In-Home Services (IHS)
Who Employs the Worker?	Participant	Agency
Supervision Responsibility	Participant self-directs care	Agency provides RN supervision
Payroll Management	Agency manages payroll & taxes	Agency manages payroll as employer
Training Requirements	Agency ensures attendant training documentation	12-hour initial & 6-hour APC training required
Oversight Level	Low to moderate	High (must follow DHSS and RN supervision rules)
Startup Cost	Lower	Higher (office, staff, RN, training)
Profit Potential	Moderate	Higher (can bill for more services)
Best For	Entrepreneurs wanting lower overhead	Owners seeking to build a full-service care agency

Which Program Is Right for You?

The best choice depends on your goals, resources, and long-term vision.

Choose CDS if you want to:

• Start small with minimal staffing

• Operate primarily as an administrative or fiscal agency

• Serve consumers who want to hire their own attendants

• Manage operations from a small office or remote setting

Choose In-Home Services if you want to:

• Build a traditional home care agency with employees

• Offer a wider range of personal care and advanced personal care services

• Maintain direct control over care quality and supervision

• Grow into a larger, multi-staff operation over time

Many successful agencies eventually offer both programs, allowing them to serve more clients and diversify revenue streams.

How to Get Licensed for CDS or IHS in Missouri

Both programs require approval from the Missouri Department of Health and Senior Services (DHSS) and contracting through MO HealthNet.

You’ll need to:

1. Submit a business plan and in-home proposal

2. Create policies and procedures that meet state regulations

3. Establish training and quality assurance plans

4. Complete background checks and compliance setup

5. Pass readiness and on-site reviews by DHSS

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CDS vs In-Home Services: The Bottom Line

Both CDS and In-Home Services provide essential care to Missouri residents — but each comes with its own responsibilities, costs, and rewards.

If you’re unsure which path to choose, working with a consultant familiar with Missouri’s home care licensing process can save you time, money, and frustration.

Ready to Start Your Agency?

Whether you decide on CDS, In-Home Services, or both, expert guidance can help ensure your business plan, policies, and proposal meet all DHSS and MO HealthNet requirements.

👉 Book a consultation and get your compliant business plan started today.