Skip to main content
U.S. flag

An official website of the United States government

Official websites use .gov
A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS
A lock ( ) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.

Beta This is a new resource

Review of Medicaid Consumer-Directed Personal Care Assistance Program in Missouri

Announced on  | Last Modified on  | Project Number: A-07-20-03243
Status
Completed
Agency
Centers for Medicare and Medicaid Services

OBJECTIVE

Medicaid Consumer-Directed Personal Assistance Programs provide an alternative way of receiving home care services in which consumers have more control over who provides their care and how it is provided. Rather than assigning a home care agency that controls selection, training, and scheduling of aides, the consumer, or the family member, friend, or guardian directing his or her care, performs all these functions usually done by the agency. Eligible individuals include those eligible for services provided by a certified home health agency, a long-term home health care (waiver) program, AIDS home care program, or personal care (home attendant). Prior OIG work has shown vulnerabilities in personal care programs resulting in ineligible beneficiaries and Medicaid payments that do not comply with Federal and State regulations. We will determine whether selected States made Medicaid payments for consumer-directed personal assistance program claims in accordance with applicable Federal and State regulations.

TIMELINE

  • June 15, 2020
    Announced
  • February 23, 2023
    Complete

    Review of Medicaid Consumer-Directed Personal Care Assistance Program in Missouri has been marked as complete. This audit resulted in 5 recommendations.

REPORT PUBLISHED

Missouri Claimed Federal Medicaid Reimbursement for Tens of Millions in Consumer-Directed Personal Care Assistance Services That Did Not Comply With Federal and State Requirements (A-07-20-03243)

23-A-07-044.01 to CMS - Open Unimplemented
Update expected on 04/02/2026
We recommend that the Missouri Department of Social Services refund $34,171,397 (Federal share) in overpayments to the Federal Government.

23-A-07-044.02 to CMS - Open Unimplemented
Update expected on 04/02/2026
We recommend that the Missouri Department of Social Services work with CMS to determine the allowability of $87,018,594 (Federal share) that we have set aside, and refund to the Federal Government any amount that is determined to be unallowable.

23-A-07-044.03 to CMS - Closed Implemented
Closed on 09/30/2024
We recommend that the Missouri Department of Social Services monitor consumer-directed PCA providers to ensure compliance with the State agency's established policies and procedures such that timesheets are completed and the tasks performed are described accurately and in sufficient detail; units of service charged on timesheets do not exceed the units allowable on the recipients' plans of care; consumer-directed PCA providers maintain documentation showing that attendants are registered, screened, and employable pursuant to the FCSR; and plans of care are signed.

23-A-07-044.04 to CMS - Closed Implemented
Closed on 09/30/2024
We recommend that the Missouri Department of Social Services establish policies and procedures to ensure that timesheets include fully accurate and complete details on the specific tasks performed.

23-A-07-044.05 to CMS - Closed Implemented
Closed on 10/02/2025
We recommend that the Missouri Department of Social Services establish and implement policies and procedures to specify what consumer-directed PCA providers must include in their emergency backup plans for recipients and require development of pandemic preparedness plans and implement training to educate consumer-directed PCA providers on these plans.

View in Recommendation Tracker
Work Plan Type
Office of Audit Services
HHS Agencies
Centers for Medicare and Medicaid Services
Issue Areas
Financial Stewardship
Target Groups
-
Financial Groups
Medicaid