The short answer Missouri centers screening on the Family Care Safety Registry: in-home care workers must register, and employers must run FCSR checks that bundle criminal history, the Employee Disqualification List, and abuse/neglect records.
What Missouri requires
Missouri
Family Care Safety Registry. §§ 210.900-210.936 RSMo require child and elder care workers, including in-home caregivers, to register with the Family Care Safety Registry; employers call or query the FCSR, which returns Missouri criminal records, EDL status, child abuse/neglect findings, and foster/child care licensing sanctions.
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Provider check mandate. § 192.2495 RSMo (transferred in 2014 from § 660.317) requires in-home services providers and home health agencies to request a criminal background check and FCSR screening for each employee within specified timeframes after hire and bars employment of persons with disqualifying convictions absent a Good Cause Waiver.
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Employee Disqualification List. The DHSS Employee Disqualification List names individuals with substantiated abuse, neglect, or misappropriation findings; listed persons may not be employed in direct care by any covered provider.
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Good Cause Waiver. Applicants with otherwise disqualifying convictions may apply to DHSS for a Good Cause Waiver demonstrating rehabilitation, which restores eligibility for in-home care employment.
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The federal baseline (applies in every state)
Federal
No universal federal mandate. There is no federal law requiring criminal background checks for private-pay home care workers; requirements are set state by state. HHS OIG found wide variation in state home health background check requirements, and Medicare Conditions of Participation for home health agencies defer to state law on screening.
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National Background Check Program (ACA Section 6201). Section 6201 of the Affordable Care Act created the CMS National Background Check Program, which awarded grants to more than 25 states to build fingerprint-based, comprehensive background check systems for direct patient access employees of long-term care providers, including home health agencies and personal care providers.
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FCRA obligations. When an agency uses a consumer reporting agency (third-party background check vendor), the federal Fair Credit Reporting Act requires a standalone written disclosure, the applicant's written authorization, and the pre-adverse action / adverse action notice process (copy of the report and Summary of Rights) before rejecting a candidate based on the report.
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OIG exclusion list (LEIE). Home care providers that bill Medicare or Medicaid must not employ or contract with individuals excluded from federal health care programs. HHS OIG maintains the List of Excluded Individuals/Entities (LEIE); CMS and state Medicaid agencies expect screening at hire and monthly thereafter, and payments tied to excluded persons are subject to recovery and civil monetary penalties.
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