In Missouri, the license families see for assisted living is "Assisted Living Facility (ALF)", issued by the Missouri Department of Health and Senior Services, Section for Long-Term Care Regulation. Each resident admitted or readmitted must have an admission physical exam by a licensed physician; the facility must request the record before move-in and have it on file within 10 days after admission. An assisted living facility must give written notice at least 30 days before discharging a resident, along with notice of the right to a hearing, except in an emergency.
Key facts
- The median monthly cost of assisted living in Missouri was $5,400 in CareScout's 2025 Cost of Care Survey, or $64,800 a year, $800 below the national median of $6,200 a month. (CareScout, 2026)
- Missouri Medicaid (MO HealthNet) can pay for extra personal care for assisted living residents through its RCF/ALF Personal Care program, but only for people with active Medicaid who meet nursing facility level of care and need more than the facility must provide. (Missouri Department of Health and Senior Services, 2026)
- Within one month before or one week after admission, a new resident needs the first step of a two-step Mantoux (PPD) skin test, and if it is negative the second step follows one to three weeks later. (19 CSR 20-20.100, 2000)
- Injections may be given only by a physician or licensed nurse, except that insulin injections may also be given by a certified medication technician or level I medication aide who passed the state-approved insulin course. (19 CSR 30-86.047, 2012)
- A facility that locks, secures or separates a unit for residents with Alzheimer's disease and advertises specialized dementia care must file a disclosure with the state on how its care differs and give a copy to residents and next of kin at admission. (RSMo 198.505 and 198.510, 2014)
Missouri licenses assisted living facilities (ALF) and, separately, residential care facilities (RCF), and the Department of Health and Senior Services sets the ALF standards in 19 CSR 30-86.047. An ALF that keeps residents who cannot get out of the building with minimal help must also meet 19 CSR 30-86.045, and some older facilities that were licensed as RCF II in 2006 hold an ALF license under the older RCF II standards in 19 CSR 30-86.043. The facts below are for the main ALF license.
Rules change and communities can set stricter policies. Before you sign, confirm the details with the community and the Missouri Department of Health and Senior Services, Section for Long-Term Care Regulation. This page is general information, not legal advice.
The rules at a glance
| Medical assessment before move-in | Each resident admitted or readmitted must have an admission physical exam by a licensed physician; the facility must request the record before move-in and have it on file within 10 days after admission. A pre-move-in screening is also required, and a community-based assessment must be done within 5 calendar days of admission. [5][6] More on this |
|---|---|
| TB test | Within one month before or one week after admission, a new resident needs the first step of a two-step Mantoux (PPD) skin test, and if it is negative the second step follows one to three weeks later. A chest X-ray from the month before admission plus a check for TB symptoms may be accepted until the two-step test is done. [7][8] More on this |
| Notice before a move-out | An assisted living facility must give written notice at least 30 days before discharging a resident, along with notice of the right to a hearing, except in an emergency. Missouri law allows discharge only for medical reasons, for the welfare of the resident or other residents, or for nonpayment. [9][10] More on this |
| Who may give medications | Injections may be given only by a physician or licensed nurse, except that insulin injections may also be given by a certified medication technician or level I medication aide who passed the state-approved insulin course. Anyone who gives medications must be at least 18 and, unless a physician or licensed nurse, a certified medication technician or level I medication aide. [11] More on this |
| Memory care and dementia | A facility that locks, secures or separates a unit for residents with Alzheimer's disease and advertises specialized dementia care must file a disclosure with the state on how its care differs and give a copy to residents and next of kin at admission. Direct care staff for residents with dementia need at least 3 hours of dementia orientation training. [12][13] |
| Long-term care ombudsman | Missouri's Long-Term Care Ombudsman Program, part of the Department of Health and Senior Services, helps residents of facilities licensed under Chapter 198, which includes assisted living facilities, and can be reached at 800-309-3282. [14][15][16] Official page More on this |
| Medicaid help | Missouri Medicaid (MO HealthNet) can pay for extra personal care for assisted living residents through its RCF/ALF Personal Care program, but only for people with active Medicaid who meet nursing facility level of care and need more than the facility must provide. Room and board are meant to be paid from the resident's income and a state cash grant. [17] Official page More on this |
What assisted living costs in Missouri
The median monthly cost of assisted living in Missouri was $5,400 in CareScout's 2025 Cost of Care Survey, or $64,800 a year, $800 below the national median of $6,200 a month. [18]
A median is the middle of the rates communities reported, so many charge more or less. Rates differ between regions and by the care a resident needs, so ask each community for its full fee list in writing. More: assisted living costs in every state, a monthly budget and the costs that aren't in the base rate.
How to check a community in Missouri
The Department's Show Me Long Term Care site lets families pick a county, city or zip code and see how any licensed long-term care facility did on its last inspection, and it covers inspection and complaint results for assisted living and residential care facilities. Complaints about a facility can be made to the Adult Abuse and Neglect Hotline at 1-800-392-0210. Search Missouri's records. [3][4]
The licensing agency: Missouri Department of Health and Senior Services, Section for Long-Term Care Regulation. [1][2] Our guide on how to read an inspection report explains what to look for.
Put Missouri's paperwork on a date
Parent Move Plan counts every task back from the move-in day, including the medical assessment and TB screening the community will ask for, so nothing lands in the last week.
Get your first 3 days freeFrequently asked questions
How much does assisted living cost in Missouri?
The median monthly cost of assisted living in Missouri was $5,400 in CareScout's 2025 Cost of Care Survey, or $64,800 a year, $800 below the national median of $6,200 a month. A median is the middle of the rates communities reported, so many charge more or less, and rates differ between regions and by the care a resident needs.
What medical assessment does Missouri require before moving into assisted living?
Each resident admitted or readmitted must have an admission physical exam by a licensed physician; the facility must request the record before move-in and have it on file within 10 days after admission. A pre-move-in screening is also required, and a community-based assessment must be done within 5 calendar days of admission.
Does Missouri require a TB test for assisted living?
Within one month before or one week after admission, a new resident needs the first step of a two-step Mantoux (PPD) skin test, and if it is negative the second step follows one to three weeks later. A chest X-ray from the month before admission plus a check for TB symptoms may be accepted until the two-step test is done.
How much notice must an assisted living community in Missouri give before a move-out?
An assisted living facility must give written notice at least 30 days before discharging a resident, along with notice of the right to a hearing, except in an emergency. Missouri law allows discharge only for medical reasons, for the welfare of the resident or other residents, or for nonpayment.
Who can give medications in assisted living in Missouri?
Injections may be given only by a physician or licensed nurse, except that insulin injections may also be given by a certified medication technician or level I medication aide who passed the state-approved insulin course. Anyone who gives medications must be at least 18 and, unless a physician or licensed nurse, a certified medication technician or level I medication aide.
Who can help with a complaint about assisted living in Missouri?
Missouri's Long-Term Care Ombudsman Program, part of the Department of Health and Senior Services, helps residents of facilities licensed under Chapter 198, which includes assisted living facilities, and can be reached at 800-309-3282.
Does Medicaid pay for assisted living in Missouri?
Missouri Medicaid (MO HealthNet) can pay for extra personal care for assisted living residents through its RCF/ALF Personal Care program, but only for people with active Medicaid who meet nursing facility level of care and need more than the facility must provide. Room and board are meant to be paid from the resident's income and a state cash grant.
Sources
- Missouri Department of Health and Senior Services: Nursing Homes and Other Long-Term Care, Licensing and Certification (2026) (checked October 22, 2026)
- Missouri Department of Health and Senior Services: Level of Licensure for Long Term Care Facilities (2026) (checked October 22, 2026)
- Missouri Department of Health and Senior Services: Show Me Long Term Care in Missouri (2026) (checked October 22, 2026)
- Missouri Department of Health and Senior Services: Selecting a Nursing Home or Long-Term Care Facility (2026) (checked October 22, 2026)
- 19 CSR 30-86.047(26) and (28), Administrative, Personnel, and Resident Care Requirements for Assisted Living Facilities (via Cornell LII), 2012 (checked October 22, 2026)
- RSMo 198.073, Persons eligible for care in residential care facility or assisted living facility (Missouri Revisor of Statutes), 2007 (checked October 22, 2026)
- 19 CSR 20-20.100(2), Tuberculosis Testing for Residents and Workers in Long-Term Care Facilities and State Correctional Centers (via Cornell LII), 2000 (checked October 22, 2026)
- 19 CSR 30-86.047(19), Administrative, Personnel, and Resident Care Requirements for Assisted Living Facilities (via Cornell LII), 2012 (checked October 22, 2026)
- RSMo 198.088, Facilities to establish policies and procedures, rights of residents (Missouri Revisor of Statutes; text in effect since 1994), 2026 (checked October 22, 2026)
- 19 CSR 30-86.047(2) and (29), Administrative, Personnel, and Resident Care Requirements for Assisted Living Facilities (via Cornell LII), 2012 (checked October 22, 2026)
- 19 CSR 30-86.047(45) and (46), Administrative, Personnel, and Resident Care Requirements for Assisted Living Facilities (via Cornell LII), 2012 (checked October 22, 2026)
- RSMo 198.505 and 198.510, Alzheimer's Special Care Disclosure Act (Missouri Revisor of Statutes), 2014 (checked October 22, 2026)
- 19 CSR 30-86.047(63), Administrative, Personnel, and Resident Care Requirements for Assisted Living Facilities (via Cornell LII), 2012 (checked October 22, 2026)
- Missouri Department of Health and Senior Services: Long-Term Care Ombudsman (2026) (checked October 22, 2026)
- RSMo 192.2300, Definitions for the Office of State Ombudsman for Long-Term Care Facility Residents (Missouri Revisor of Statutes), 2014 (checked October 22, 2026)
- RSMo 198.006, Definitions (Missouri Revisor of Statutes), 2022 (checked October 22, 2026)
- Missouri Department of Health and Senior Services: Home and Community Based Services Policy Manual, 3.20 RCF/ALF Personal Care, State Plan (revised March 2026), 2026 (checked October 22, 2026)
- CareScout: Cost of Care Survey 2025, Ranked Median Costs by State (2026) (checked October 22, 2026)