Missouri’s most vulnerable citizens deserve stability, continuity of care, and trusted advocates. Yet the State of Missouri has announced the elimination of state Support Coordinator positions within the Department of Mental Health’s Division of Developmental Disabilities, transitioning these responsibilities to private Targeted Case Management (TCM) agencies.

This decision affects far more than the state employees whose positions are being eliminated. It directly impacts individuals with intellectual and developmental disabilities, their families, legal guardians, service providers, and the established support systems they depend on.

We are calling on Governor Mike Kehoe, the Missouri Department of Mental Health, and state leadership to reverse this decision, preserve state Support Coordinator positions, and protect the right of individuals and guardians to choose and retain their trusted Support Coordinators.

Support Coordinators Are More Than Case Managers

For those unfamiliar with the role, Support Coordinators are responsible for helping individuals with developmental disabilities access the services, resources, and supports necessary to live safe, meaningful, and fulfilling lives.

Their responsibilities extend far beyond completing paperwork or coordinating appointments.

Support Coordinators:

Develop and maintain individualized support plans that reflect each person’s unique needs, preferences, goals, and circumstances.

Coordinate essential services, including residential supports, personal assistance, day programs, employment services, community integration, behavioral supports, and healthcare-related services.
Monitor individuals’ health, safety, well-being, and quality of life through ongoing communication, assessments, and visits.
Identify unmet needs, service deficiencies, potential neglect, rights violations, and concerns involving service providers.

Advocate for individuals who may have limited communication abilities or difficulty advocating for themselves.
Assist families and guardians in navigating complicated Medicaid waiver programs, state regulations, eligibility requirements, and service systems.

Monitor whether providers are delivering appropriate services and meeting the individual’s needs.

Respond to crises, coordinate necessary interventions, and help prevent individuals from falling through the cracks.

Promote independence, informed choice, personal rights, community inclusion, and opportunities for individuals to live fulfilling lives.

Support Coordinators serve as a critical layer of oversight and advocacy within Missouri’s developmental disability service system.

They are not simply managing cases. They are protecting people.

These Are Human Relationships, Not Case Numbers

One of the most concerning statements communicated during this transition is that nothing will change for consumers other than the identity of their Support Coordinator.

That statement fundamentally minimizes the importance of established relationships and continuity of care.

Support Coordinators spend months and years getting to know the individuals they serve. They become familiar with their medical histories, behavioral needs, communication styles, personal preferences, family dynamics, support requirements, and individual goals.

They develop relationships built on familiarity, consistency, and trust.

Some individuals have difficulty communicating with unfamiliar people. Others experience significant anxiety when routines or relationships change. Some depend on their Support Coordinator to recognize subtle changes in behavior, identify unmet needs, or understand concerns they cannot easily communicate.

Families and guardians rely on these established relationships as well. They know whom to contact when concerns arise, whom to trust when services are inadequate, and who understands their loved one’s unique circumstances.

Service providers also depend on consistent communication and collaboration with Support Coordinators to address concerns, coordinate services, and maintain appropriate supports.

These relationships do not develop overnight.

The trust that has been established cannot simply be transferred through paperwork.

Changing someone’s Support Coordinator is not the equivalent of changing a name in a computer system. It can mean losing a familiar face, a trusted advocate, an established relationship, and someone who genuinely understands their needs.

Consumers and guardians are already expressing concerns about this transition. Some are specifically requesting that their current state Support Coordinators remain involved in their lives.

Their voices deserve to be heard.

Serious Concerns Regarding Private Targeted Case Management

The decision to transfer state Support Coordination responsibilities to private TCM agencies raises significant questions regarding service quality, staffing capacity, accountability, and consumer protection.

Private TCM agencies already operate throughout Missouri, and many individuals receive services through these organizations. This petition is not intended to suggest that every private agency provides inadequate services or that every private case manager fails to fulfill their responsibilities.

However, concerns regarding some agencies cannot be ignored.

Support Coordinators and others involved in Missouri’s developmental disability service system have encountered situations involving inadequate communication, inconsistent consumer contact, difficulty identifying assigned case managers, and concerns regarding whether individuals are receiving the oversight and advocacy they require.

There are also concerns regarding Medicaid billing practices and whether all billed services are consistently being delivered in accordance with applicable requirements. Any credible allegations of improper billing or failure to provide required services deserve appropriate investigation and oversight.

These concerns raise important questions.

How will agencies that may already struggle with existing caseloads manage a significant influx of additional consumers?

What safeguards will ensure individuals receive required monitoring visits and meaningful service coordination?

How will the State verify that agencies have sufficient staffing, training, experience, and resources?

What accountability measures will be established when services are not delivered appropriately?

How will consumers and guardians report concerns, and how quickly will those concerns be addressed?

Who will ensure that individuals with complex medical, behavioral, and support needs do not experience gaps in services?

Transferring responsibility to a private agency does not automatically guarantee equivalent service quality, continuity of care, or effective oversight.

Before implementing a transition of this magnitude, Missouri leadership should be able to demonstrate that receiving agencies are prepared to meet the needs of every individual being transferred.

Not simply through assurances, but through measurable staffing capacity, documented compliance, meaningful oversight, and enforceable accountability.

Consumer Choice Should Matter

Missouri’s developmental disability service system emphasizes individual rights, person-centered planning, informed choice, and self-determination.

Those principles should not disappear when administrative decisions are made.

If an individual or guardian is satisfied with their current state Support Coordinator, has developed a trusting relationship with that person, and believes their needs are being appropriately addressed, why should they be forced to accept a different arrangement?

Why should individuals who depend on consistency be required to establish entirely new relationships when their existing support coordination arrangement is working?

Why should guardians lose trusted professionals who understand their loved ones’ needs and have demonstrated their commitment to advocating for them?

Individuals with developmental disabilities and their guardians should have a meaningful voice in decisions that directly affect their services, relationships, and quality of life.

Preserving state Support Coordination as an available option would allow consumers and guardians to maintain established relationships while continuing to recognize the role of private TCM agencies for those who prefer them.

Choice should be more than a principle written into policy. It should be reflected in the decisions that affect people’s lives.

An Inadequately Explained Transition With Serious Consequences

The manner in which this decision has been communicated has raised additional concerns regarding transparency, planning, and accountability.

State Support Coordinators have been informed that their positions are being eliminated, yet employees have reported receiving limited answers to fundamental questions regarding the transition, future employment opportunities, financial protections, and the long-term implications for consumers.

During informational meetings, employees seeking clarification have repeatedly encountered responses indicating that answers are not yet available.

Employees have also been informed that severance pay will not be provided.

Meanwhile, they are expected to continue fulfilling their responsibilities at full capacity, meeting documentation requirements, coordinating services, monitoring consumer welfare, responding to concerns, and maintaining the same professional standards despite the uncertainty surrounding their employment.

These employees have invested significant time, effort, education, and professional experience into understanding Missouri’s developmental disability service system.

They have developed specialized knowledge of Medicaid waivers, state policies, provider requirements, service planning, health and safety monitoring, and the complex needs of the individuals they serve.

That experience cannot be easily replaced.

The relationships they have established cannot be easily recreated.

And the dedication they have demonstrated should not be disregarded.

Government restructuring may sometimes be necessary. However, decisions affecting vulnerable citizens and the employees responsible for coordinating their services should be accompanied by comprehensive planning, transparent communication, and meaningful consideration of the consequences.

If the State has developed a plan significant enough to eliminate an entire category of positions, it should also have a comprehensive plan explaining how consumers will be protected and how continuity of care will be maintained.

The public deserves to understand the justification for this decision, the anticipated benefits, the potential risks, and the safeguards being established.

The Potential Consequences Cannot Be Dismissed

For individuals with intellectual and developmental disabilities, inconsistent service coordination can have serious consequences.

A failure to identify changes in health or behavior may delay necessary intervention.

Inadequate monitoring may allow unsafe living conditions, unmet support needs, or rights violations to go unnoticed.

Poor communication between case managers, guardians, and providers may result in service disruptions, misunderstandings, or delayed responses to urgent concerns.

The loss of established relationships may create additional stress for individuals who depend on familiarity and consistency.

And when agencies are overwhelmed or unable to maintain appropriate contact, vulnerable individuals may be left without the advocacy and oversight they deserve.

These are not merely administrative inconveniences.

They are potential threats to the health, safety, rights, independence, and quality of life of real people.

Missouri cannot responsibly minimize these concerns by repeatedly assuring families that nothing will change other than the identity of their Support Coordinator.

For many individuals, that relationship is one of the most important parts of their support system.

What We Are Asking Missouri Leadership to Do

We respectfully call upon Governor Mike Kehoe, the Missouri Department of Mental Health, the Division of Developmental Disabilities, and Missouri lawmakers to:

Reconsider and reverse the decision to eliminate state Support Coordinator positions, preserving the expertise, oversight, and established relationships currently provided through state support coordination.

Preserve state Support Coordination as an available choice for individuals and guardians who wish to maintain their existing service arrangements and trusted Support Coordinators.

Provide a transparent explanation of the decision, including the reasons for eliminating these positions, the anticipated financial or administrative benefits, and the evidence supporting the proposed transition.

Conduct a comprehensive assessment of private TCM agency capacity and compliance before transferring additional consumers, including staffing levels, caseload expectations, required monitoring, service delivery, and accountability measures.

Establish meaningful opportunities for consumers, guardians, families, providers, and employees to participate in discussions regarding the proposed changes and their potential consequences.

Develop and publicly communicate a comprehensive consumer transition plan that addresses continuity of care, preservation of critical information, protection of individual rights, and prevention of service disruptions.

Provide greater transparency and meaningful support for affected state employees, recognizing their professional experience, years of service, financial concerns, and contributions to Missouri’s developmental disability service system.
Missouri’s Most Vulnerable Citizens Deserve Better

This petition is not simply about preserving government positions.

It is about protecting the people those positions were created to serve.

It is about recognizing that effective Support Coordination requires more than assigning a case number to an agency.

It requires knowledge, consistency, accountability, communication, advocacy, and trust.

It is about guardians who are frightened of losing someone who understands their child’s needs.

It is about individuals who may not understand why a familiar, trusted person is suddenly disappearing from their lives.

It is about families who have spent years navigating complicated systems and finally established relationships with professionals they can depend on.

It is about employees who have dedicated themselves to protecting vulnerable Missourians, only to learn that their positions are being eliminated without the clear answers and meaningful consideration they deserve.

And most importantly, it is about ensuring that administrative restructuring does not come at the expense of the individuals whose well-being should remain the State’s highest priority.

Support Coordinators are not disposable. Established relationships are not disposable. Professional experience is not disposable. And individuals with developmental disabilities are not simply case files to be transferred from one agency to another.

Missouri’s citizens deserve transparency.

Consumers deserve consistency.

Guardians deserve a voice.

Employees deserve consideration.

And everyone affected deserves a transition process that prioritizes people over administrative convenience.

We urge Governor Kehoe and Missouri leadership to reconsider this decision and preserve state Support Coordination services.

Please sign this petition to stand with Missouri’s individuals with developmental disabilities, their families, guardians, providers, and the Support Coordinators who have dedicated themselves to serving them.

Protect consumer choice. Preserve trusted relationships. Keep Missouri’s state Support Coordinators.