A VA pension check covers part of the cost of care. A Medicaid waiver, where Dad qualifies and a slot is open, can pay for a different part. The two programs use different income and asset rules, and the waiver's service plan decides which hours it pays for. Before you reprice the private-pay line, find out which payer is actually on the hook for each hour.
Local option: New Plan Care gives families in the St. Louis area in-home help so a parent can stay home: companionship, help with bathing and dressing, meals, and overnight care. Call (314) 405-0887.
Medicaid is not one program
Medicaid is run jointly by the federal government and each state. In-home care is usually paid through home and community-based waivers that the state operates.1 Missouri runs its own waiver and eligibility process through the state Medicaid agency. Waiting lists, enrollment windows, and provider rules change, so do not assume a waiver is open or that it will pay the aide you already interviewed.
What it costs: The Missouri median for non-medical in-home care is $33 an hour, per the CareScout (Genworth) Cost of Care Survey 2025 state data tables, released March 2026. New Plan Care's standard rate is $34 an hour with a four-hour minimum, so a visit starts at $136 (newplancare.com/services).
What moves the number
Several things change the private-pay line when a waiver is involved.
The approved hours. A waiver pays for hours on a written service plan, and plans often cap hours or group them by task. Hours the plan does not approve stay on the private-pay line.
The provider. Many waivers pay only enrolled providers. An aide you hire directly may not be paid by the waiver at all, even when the hours are approved. Ask the state agency which providers are enrolled before you sign with anyone.
The look-back. When Medicaid reviews an application for long-term services, it reviews asset transfers made in a set period before the application, usually five years.2 A gift or transfer to a family member can delay eligibility. That is a question for the state office or a licensed attorney, not one to settle informally within the family.
The pension. A VA pension and Medicaid both count income, and the two offices may not count the same figure the same way. Do not assume a change in the pension leaves Medicaid eligibility untouched. Ask both offices how each figure is counted.
What to ask before you reprice
Ask the state Medicaid office, in writing where possible: which waiver applies, whether a slot is open, how long the wait is, which hours are on the service plan, which providers are enrolled, and what happens when care needs exceed the plan. Compare the answers against the private-pay quote line by line. A waiver that covers a few hours a week leaves most of the bill private, and the budget should say so.
For how this desk checks its claims against official sources, see Sources.
1 Medicaid.gov, federal overview of home and community-based services waivers.
2 42 U.S.C. 1396p(c), Medicaid rule on transfers of assets; VA.gov pension pages describe how VA counts income and net worth, which is a separate calculation.