Missouri manual section 6.18
Individualized Supported Living (ISL)
Official service name: Individualized Supported Living
Individualized Supported Living (ISL) provides personalized supports for a person using the Comprehensive Waiver who lives in a home of their choice and needs help to live successfully and participate in the community.
What the manual describes
What this service can help with
- Self-help, social, and adaptive skills
- Activities of daily living and instrumental activities of daily living when identified in the plan
- Community participation and personal outcomes
- Direct support and professional oversight tailored to the person's plan
- A backup and safety-net plan, including a 24-hour point of contact
- Up to 24 hours of support when specified in the person-centered service plan
Source-backed working pathway
To establish you'll probably need:
These steps translate the cited manual section into a practical review sequence. Confirm the current local process before acting.
Confirm Comprehensive Waiver eligibility and an assessed residential-support need.
Work with the support coordinator and planning team to confirm that Individualized Supported Living is the appropriate service and that the required supports are identified in the person-centered service plan.
Describe the person's preferred home and living arrangement.
Discuss where and with whom the person wants to live, private-bedroom needs, community preferences, housemate considerations, and who will own or lease the home.
Define the individualized support and backup plan.
Document daily-living, health, communication, behavioral, employment, transportation, community, staffing, supervision, and emergency-backup needs. Support hours and costs are individually planned and budgeted.
Compare qualified providers and exercise free choice.
The person may choose the provider and is not required to use the same provider as housemates. Confirm the provider's Department of Mental Health contract and required certification or accreditation.
Confirm the final plan, budget, home, staffing, and start date.
Before relying on a placement, confirm authorization, actual staffing capacity, housing costs, transportation and nursing arrangements, backup coverage, and which overlapping services cannot be separately authorized.
Important boundaries
Limits that may affect fit or authorization
- Individualized Supported Living is available through the Comprehensive Waiver only.
- The home is a private dwelling and must be owned or leased by at least one person living there or by a person designated by that resident, such as a family member or legal guardian.
- No more than four people receiving Individualized Supported Living may share a residence, and each person generally has a private bedroom.
- The Division states that it cannot support a person living alone who requires more than 12 hours of staffing per day; that staffing must be shared with one or two housemates.
- Personal Assistant, Individualized Skill Development, and Community Networking are components of this service and cannot be separately authorized at the same time.
- Because activities-of-daily-living support is included, a person receiving Individualized Supported Living cannot also receive Medicaid state-plan personal care.
- Transportation and monthly registered-nurse oversight are provided through the ISL agency but are authorized and billed separately from the daily ISL rate.
- Immediate family members cannot be paid directly or indirectly for supports under this service.
- The manual lists one ISL unit per day. Provider enrollment does not establish an opening, housemate match, staffing capacity, or a suitable home.
- Comprehensive and Community Support waivers remain under a temporary renewal extension through December 27, 2026, or until CMS grants final approval. Confirm the currently approved rules with the support coordinator; proposed renewal changes are not automatically active.
Do not assume this part
Questions to confirm locally
- Which qualified providers currently have staffing capacity in the preferred area?
- Is there an existing home or housemate match, or must housing be located separately?
- What rent, utilities, food, deposit, furnishing, and transportation costs are not part of the waiver service?
- What daily, overnight, nursing, transportation, behavioral, and emergency supports are authorized?
- How will the provider cover call-offs and other staffing gaps?
- Which services are included in Individualized Supported Living and therefore cannot be separately authorized?
- If the person wants to live alone, does the assessed staffing need fit the manual's 12-hour-per-day boundary?
- Which transportation and nursing supports require separate authorization and billing?