Missouri Aged and Disabled Waiver (ADW)
The Aged and Disabled Waiver (ADW) is MO HealthNet’s waiver for older adults who need a nursing facility level of care. It adds services to state plan personal care. For the wider picture, see our Missouri Long-Term Care Medicaid guide.
Figures change periodically. Double-check current amounts before relying on them.
At a glance
| Item | Details |
|---|---|
| Type of program | Medicaid home and community-based services (HCBS) waiver |
| Who runs it | Missouri DHSS, Division of Senior and Disability Services (DSDS) |
| Age | 65 and older, or 63 to 64 with a physical disability |
| Care need | Needs a nursing facility level of care |
| Missouri 2026 income rule (long-term care) | No fixed cap for nursing home care: income goes to the facility, minus allowances |
| Missouri 2026 asset limit (single applicant) | $6,220.50 (from July 1, 2026) |
| Waiting list | No waiting list reported in 2026 |
The ADW in brief
To sum up, Missouri DHSS, Division of Senior and Disability Services (DSDS) oversees the ADW. Who it is for: 65 and older, or 63 to 64 with a physical disability. Care need required: Needs a nursing facility level of care. Waiting list status in 2026: No waiting list reported in 2026. Each of these points is covered in more depth below, alongside the general Missouri rules from our state guide. Other Missouri programs, and general guides on care at home, are linked at the end of this page for comparison with the ADW.
What the program is
DSDS assesses applicants, confirms the nursing facility level of care, and authorizes services in a person-centered care plan. ADW services add to state plan personal care, which is a separate MO HealthNet service. Participants with a spenddown must meet it before services are paid.
Under federal law, Missouri can run home and community-based waivers like the ADW, which bend some ordinary Medicaid rules so care can happen outside a facility. Waivers usually have a fixed number of slots each year, a care plan written for each person, and a case manager or support coordinator who arranges services. They do not replace regular Medicaid: a person on a waiver still has ordinary Medicaid coverage for doctor visits, hospital care and prescriptions, with Medicare paying first for people who have it. See our overview of HCBS waivers.
Who qualifies in 2026
A person generally must meet all of these conditions:
- Is 65 or older, or 63 or 64 with a physical disability
- Needs a nursing facility level of care, with impairments and unmet needs
- Qualifies for full Medicaid under Missouri’s long-term care financial rules (see the money test below)
- Has fee-for-service MO HealthNet (not managed care)
- Is not enrolled in another HCBS waiver
- Lives in Missouri and is a U.S. citizen or qualified non-citizen
The money test. The person must qualify for full Medicaid under Missouri’s rules for long-term care. The income and asset figures in the table above are Missouri’s 2026 Long-Term Care Medicaid figures from our state guide. Exempt items generally include the home within the equity cap, a car, household goods and a modest burial fund. If only one spouse needs the ADW, spousal impoverishment rules protect assets and income for the other. See Spousal impoverishment rules.
What the care test means in practice. The care test looks at how much help a person needs with everyday activities such as bathing, dressing, eating, using the toilet, moving around and taking medicines, and at memory problems and supervision needs. For the ADW, an assessor, usually a nurse or social worker, visits the person at home, in the hospital or in the facility. Before a the ADW assessment, it helps to line up a family member who can describe a typical bad day, and to have a list of diagnoses and medications ready. See Nursing home level of care and Activities of daily living.
What services it can pay for
Services depend on the person’s assessed needs and written care plan. Depending on the plan, they can include:
- Adult day care
- Homemaker
- Chore
- Home-delivered meals
- Respite
Not every participant gets every service; the plan reflects assessed need and the help family already gives. If needs change, ask for a new assessment.
How to apply
Getting the ADW means passing a money test and a care test. Step by step:
- Use DSDS’s online HCBS referral.
- Assessment.
- Apply for MO HealthNet.
Our documents checklist and Applying for a waiver guide list the paperwork.
Waiting lists
Missouri reported no waiting list for older adults on the ADW in 2026.
General advice is in Waiver waiting lists.
How it relates to nursing home Medicaid
ADW uses the nursing facility level of care. Missouri nursing home Medicaid has no fixed income cap, and the asset limit is $6,220.50 from July 1, 2026. Home care participants with a spenddown must meet it before services are paid.
What is the same as nursing home Medicaid. As in nearly every state, Missouri’s financial rules for home and community programs follow its nursing home rules closely. The five-year look-back still matters: a transfer for less than fair value can delay payment for long-term care services. After death, estate recovery can reach services paid from age 55 on. People who keep income above a set allowance may have to pay part of it toward their care each month.
Personal needs allowance. If the person does move to a nursing home, Missouri’s 2026 personal needs allowance is $50 a month. Most of the rest of their income goes toward the cost of care. Details are in our state guide.
Tips for families
- Do not wait for a crisis. Lists and assessments for the ADW take time, and the start date is usually when you first request help.
- Document everything, from forms and letters to who you spoke with at MO HealthNet and when.
- Read every notice. If services are denied, cut or ended, the notice explains how to request a fair hearing and the deadline. Requesting one before the deadline often keeps services in place during the appeal.
- Report changes in income, assets, address or living situation to MO HealthNet when they happen.
- Plan for renewals. Medicaid and the care assessment are both renewed, usually once a year. See Renewals.
- Protect a spouse at home. Spousal protections must be claimed; a certified Medicaid planner or legal aid office can explain them for your family.
Common questions
Do I have to meet a spenddown? Yes, if you have one. Services are paid once it is met.
Can family be paid? Through state plan Consumer Directed Services, family members other than a spouse can be hired.
Does ADW pay for assisted living? No. Some state plan personal care can be given in residential care or assisted living facilities.
Related pages
- Missouri Long-Term Care Medicaid guide
- Missouri personal care program
- Three kinds of Long-Term Care Medicaid
- PACE programs
Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.