Will Missouri DD services stop when a support coordinator changes?

The Division of Developmental Disabilities told clients in an Oct. 28 letter to keep meeting with their current support coordinator until the division or a new case management agency contacts them about the transfer. The plan changes who provides support coordination, and the transfers are due to be finished by Dec. 31, 2027.

What is conflict-free case management?

Under federal Medicaid HCBS rules, the agency that provides a person's waiver services generally may not also be that person's case manager or write their service plan. States can make an exception only where a single qualified entity is available in an area, with protections approved by CMS.

Missouri to move 5,152 off state DD case management by 2027

Missouri's DD division will move the 5,152 people it still case-manages to contracted agencies by Dec. 31, 2027, the Missouri Independent reported. The state expects to save about $3 million a year; some families and advocates worry about disruption and oversight.

missouri · case-management · support-coordination · hcbs · developmental-disabilities

Direct Support News desk · November 13, 2026 · Updated November 14, 2026 · 3 min read

Missouri's Division of Developmental Disabilities plans to hand its last state-run case management caseload, 5,152 people, to contracted agencies over the next two years, finishing by Dec. 31, 2027. The Missouri Independent reported the plan Nov. 13, citing the Department of Mental Health and an Oct. 28 letter the division sent to clients.

The shift eliminates more than 200 state support coordination positions. Current employees will get preference for other openings in the division's regional offices, but none is guaranteed a job, the Independent reported.

Who is affected

In Missouri, support coordinators write and monitor each person's individual support plan and help them get services, many of them paid for by Medicaid. The division already uses two kinds: its own staff, and coordinators at Targeted Case Management (TCM) agencies, which are nonprofits or county developmental disability boards under contract with the state, as the division's August newsletter describes.

About 87% of people eligible for division services already work with a contracted coordinator, according to the Independent. Of the 5,152 people still served by state staff, 92% live in the Kansas City and St. Louis metro areas. The division's letter tells them to keep meeting with their current coordinator "as you usually would" until the division or a new agency contacts them about the transfer.

Why the state is doing it

The department says the change will deal with caseload growth and let division staff focus on contract management, quality and compliance. It expects to save about $3 million a year, public affairs director Debra Walker told the Independent, and says it has already confirmed that contractors have room for the transferred clients.

This is the last step of a longer move. Lawmakers put $7.6 million in the fiscal 2023 budget to shift 2,400 people from state to contracted coordinators, according to the department's fiscal 2024 budget request as cited by the Independent. State coordinators' average caseload fell from 49 to 39 that year and was 29 in fiscal 2026; contracted coordinators have averaged 33 to 35 over the past five years.

Nancy Pennington, executive director of the Missouri Association of County Developmental Disability Boards, told the Independent that contractors can hire as caseloads grow, while the division is capped by its annual staffing allotment.

The worries

Some families and advocates fear the handoff will interrupt services, especially for families who don't know the system well. A petition asking the department and Gov. Mike Kehoe to keep state support coordination as an option gathered more than 1,000 signatures in a week, the Independent reported. A St. Louis County parent said he worries that, over time, financial pressure could push contracted agencies to raise caseloads.

Others raised oversight. Federal Medicaid rules for HCBS bar providers of a person's services, and anyone employed by or with an interest in them, from also doing that person's case management or writing their plan, except where the state shows that only one qualified entity is available in an area (42 CFR 441.301(c)(1)(vi)). Walker told the Independent that Missouri is conflict-free: contracted case management agencies can't provide other waiver services to people with developmental disabilities. Pennington said some county boards provide both services and case management, but never to the same people.

The division is also building a single statewide electronic case management system, called ConneXion, for both state and TCM coordinators. Its August newsletter said it expected to pick a vendor in October 2026 and to start the project formally in April 2027.

What this means for providers and DSPs

TCM agencies in Kansas City and St. Louis will take most of the new cases. Agencies there should expect transfers through 2027 and plan hiring for caseloads that have run at 33 to 35 per coordinator.
Expect new contacts on existing plans. Provider agencies and direct support professionals serving people who change coordinators may get a new person asking about the support plan, service authorizations and incident follow-up. Keeping documentation current makes the handoff smoother.
Transfers are a risk point for plans. Authorizations and plan reviews that fall due in the middle of a transfer can slip during the handoff. Providers can flag upcoming plan dates to both the outgoing and incoming coordinator.
Families may lean on DSPs for answers. Staff who hear concerns can point families to the division's regional office or the new agency named in the transfer notice.