Missouri SB40 Boards and DD Regional Services: How County Boards Support Adults with Disabilities

What SB40 Boards Are and Why They Matter for Transition

Senate Bill 40 boards are county-level boards established under Missouri law that fund local services for individuals with intellectual and developmental disabilities. They're funded by dedicated county property tax levies — the specific tax rate and services offered vary by county.

For families navigating the transition from school to adult services, SB40 boards are often the first point of contact at the local level. In many Missouri counties, the SB40 board provides Targeted Case Management (TCM), which means the Service Coordinator who helps your child access DD waivers, plan services, and navigate the Division of Developmental Disabilities system works for the county board, not directly for DMH.

Not every county has an SB40 board. In counties without one, case management is provided directly by the Department of Mental Health (DMH) regional office. But in counties that do have a board, the SB40 system is the primary pathway to adult DD services.

How SB40 Boards Connect to DMH

The Division of Developmental Disabilities within DMH is the state-level agency responsible for eligibility determinations, waiver administration, and service oversight. SB40 boards operate at the county level under an administrative agreement with DMH.

The practical flow looks like this: a family contacts their regional DMH intake office to confirm developmental disability eligibility. Once eligibility is established, DMH either assigns a Service Coordinator from the regional office or refers the family to the county SB40 board for case management. In SB40 counties, the board's case manager becomes the family's primary contact for developing the Individual Support Plan (ISP), identifying service providers, and applying for Medicaid HCBS waivers.

SB40 boards also fund services directly through their tax revenue — day programs, recreation activities, respite care, transportation assistance, and community integration supports — that supplement what the Medicaid waivers cover. In some counties, the SB40 board is the local fiscal agent for the Partnership for Hope waiver, contributing county matching funds alongside federal and state dollars.

Regional DMH Offices

Missouri's Division of DD operates through regional offices that serve as the intake point for families seeking adult services. Each regional office covers a cluster of counties, and the office serving your area depends on your county of residence.

The regional office handles:

• Initial intake and eligibility determination
• Prioritization of Need scoring for waiver waitlists
• Connecting families to local Service Coordinators
• Oversight of service providers in the region

For families in urban areas, the St. Louis and Kansas City regional offices serve high-population counties with relatively dense provider networks. For rural families, satellite offices like Albany, Kirksville, or Poplar Bluff cover large geographic areas with fewer providers and longer travel distances.

The MAAS Assessment and Prioritization of Need

DMH uses the Missouri Adaptive Ability Scale (MAAS) to evaluate an individual's functional abilities across daily living domains. The MAAS results feed into the Prioritization of Need (PON) score, which helps determine the individual's priority for waiver services.

PON scores run from 1 to 5. Scores 1 through 4 are based on the individual's overall MAAS score; PON 5 is based on verified crisis criteria. Higher PON scores receive priority before lower scores, with time on the list relevant among people with the same score.

Partnership for Hope and County Funding

The Partnership for Hope waiver is uniquely tied to SB40 boards. Unlike the Comprehensive and Community Support waivers, which are funded entirely through federal and state Medicaid dollars, Partnership for Hope requires a local county match. The SB40 board provides this match through its tax levy.

This county-funding structure has consequences. Counties with active, well-funded SB40 boards can support more Partnership for Hope slots. Counties without SB40 boards — or with boards that allocate their levy to other priorities — may have fewer slots available.

The Partnership for Hope waiver carries a $12,362 annual cap per participant and covers basic personal assistance, minor home and vehicle modifications, specialized medical equipment, and short-term respite. It's designed for individuals who need lower levels of support to remain in their homes and communities.

What to Do Before School Exit

For families of students with intellectual or developmental disabilities, the SB40 board and DMH regional office should be on your radar well before graduation:

Contact the regional DMH intake office well before school exit to start the eligibility process. Starting early gives time for eligibility and waiver-application steps before school-based services end.

Identify whether your county has an SB40 board. If it does, contact them directly to learn what local services they fund and how case management works in your county. Some boards host informational meetings and transition workshops for families.

Attend a person-centered planning meeting with the assigned Service Coordinator. This meeting develops the Individual Support Plan, which maps out the services, goals, and supports the individual will receive in adulthood.

Ask about county-specific resources. SB40 boards often fund programming that isn't available through Medicaid waivers alone — recreational activities, social clubs, community events, and transportation subsidies that make a tangible difference in daily life.

The Missouri IEP Transition to Adulthood Guide includes a regional resource directory with DMH office contacts, a list of counties with active SB40 boards, and a step-by-step intake checklist for connecting with adult DD services while your child is still in school.

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