Missouri manual section 6.33
Supported employment
Official service name: Supported Employment
Supported Employment provides ongoing help for a person to obtain and maintain paid competitive integrated work. It may be individual support, including support for self-employment, or a small group of two to four workers in a regular community business or industry setting.
What the manual describes
What this service can help with
- Learning and performing job duties through job coaching and natural-support development
- Maintaining attendance, workplace inclusion, job performance, and long-term employment
- Using individual support for competitive, customized, or self-employment
- Working in a small integrated community business-based group or mobile crew of two to four workers
- Reporting and managing earnings with Social Security and Medicaid
- Planning a business and identifying financing or supports for self-employment
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.
Define the paid-employment goal and support model.
Use the person-centered service plan to identify the job or self-employment goal, current employment status, individual or small-group model, support needs, and the person's preference for the most integrated and independent arrangement.
Clarify Vocational Rehabilitation and employer responsibilities.
Document whether Vocational Rehabilitation is responsible, unavailable, exhausted, or being braided without duplication. Separate waiver support from ordinary employer training, supervision, accommodations, and other supports available to workers without disabilities.
Choose a qualified provider and arrange related supports.
Confirm the provider's Department of Mental Health certification or accepted accreditation, contract, trained staff, authorized units, and the separate plans for transportation, Personal Assistance, communication, technology, or other unmet needs.
Create an individualized employment-support plan.
Specify job coaching, task training, natural-support development, attendance and inclusion strategies, performance monitoring, fading of paid supports, earnings reporting, and any self-employment guidance. For group service, confirm two to four workers and an integrated community business setting.
Review employment outcomes and adjust support.
Use monthly progress reports and data to review job stability, wages, hours, independence, natural supports, risks, and whether paid support can safely fade. Review the employment model at least annually and when the person's goals or abilities change.
Important boundaries
Limits that may affect fit or authorization
- Supported Employment must lead to or maintain paid work in an integrated setting at or above minimum wage and not below customary wages and benefits for similar work.
- Small-group support is limited to two to four workers in regular community business or industry settings. It cannot be facility-based or otherwise nonintegrated and is not appropriate when the person can and wants to work independently.
- Waiver funds may help plan self-employment but cannot pay business startup or operating expenses.
- The service cannot pay for ordinary employer supervision, training, support, adaptations, or Americans with Disabilities Act responsibilities available to workers without disabilities.
- Vocational Rehabilitation and waiver supports may be coordinated only when records show that services do not duplicate or supplant one another. The manual lists circumstances for individual support without a Vocational Rehabilitation referral; group support needs no referral because Vocational Rehabilitation does not provide it.
- Personal Assistance may support participation but cannot replace Supported Employment or make up the entire service.
- Transportation is not included in the Supported Employment rate and must be arranged separately when needed.
- The billing table lists a maximum of 48 fifteen-minute units per day for individual support and 32 units per day for group support.
- 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
- Is the work paid, integrated, and compensated at or above applicable minimum and customary wage levels?
- Does the person need individual support, self-employment support, or a group of two to four, and why?
- What is Vocational Rehabilitation providing or unable to provide, and how will duplication or supplanting be prevented?
- Which supports are the employer's responsibility, and which individualized supports remain unmet?
- How will transportation, Personal Assistance, accommodations, technology, and earnings reporting be handled?
- What daily units are authorized, and how will progress, natural supports, and safe fading of paid support be reviewed?