Paul Sanchez
Medicaid is a healthcare program for low-income persons of all ages in Missouri, and it is called MO HealthNet. The program is jointly funded by the state and federal governments and administered by the state under federally set parameters. It covers low-income children and adults, the aged, blind, or disabled, and seniors aged 65 and over. Many Medicare beneficiaries in Missouri receive assistance through Medicaid with the cost of Medicare premiums, co-pays, deductibles, and services Medicare doesn't cover, such as long-term care. This raises the question: can you use Medicaid as a secondary insurance in Missouri?
| Characteristics | Values |
|---|---|
| Name of Medicaid in Missouri | MO HealthNet |
| Administering Agency | Missouri Department of Social Services |
| Type of Funding | Jointly funded by the state and federal government |
| Eligibility | Low-income children and adults, people with low incomes and low asset levels who are aged, blind, or disabled |
| Income Limit for Adults Under 65 | Household income up to 138% of the poverty level |
| Income Limit for Blind People | $1,305 / month for a single applicant and $1,763 / month for a married couple |
| Income Limit for Single Nursing Home Applicant | $5,909.25 |
| Monthly Income for Nursing Home Costs | All of the beneficiary's monthly income, except for a $50 personal needs allowance, Medicare premiums, and a potential allowance for a non-applicant spouse |
| Managed Care Health Plan | Members can change their primary care provider at least two times each year |
| Non-Emergency Medical Transportation (NEMT) Program | Arranges transportation for members to get to their non-emergency medical appointments |
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What You'll Learn
MO HealthNet eligibility
In Missouri, Medicaid is called MO HealthNet. MO HealthNet is available to low-income children and adults, as well as people with low incomes and low asset levels who are aged, blind, or disabled.
Eligibility
- Adults under 65 years old with a household income up to 138% of the poverty level are eligible for Medicaid.
- Infants under one year old are eligible for Medicaid if their household income is up to 201% of the poverty level. This amounts to nearly $50,000 in annual income for a household of three in 2023.
- Children aged 1-18 are eligible if their household income is up to 155% of the poverty level. For a household of three in 2023, this amounts to just over $38,500 in annual income.
- Parents with dependent children are eligible with household incomes up to 18% of the Federal Poverty Level (FPL).
- Children are eligible for Medicaid or CHIP with household incomes up to 300% of FPL.
- Pregnant women are eligible with household incomes up to 196% of FPL.
Enrollment
You can enroll in MO HealthNet online through HealthCare.gov or directly through the MO HealthNet website. You can also enroll by phone at 1-800-318-2596. The Missouri Department of Social Services Family Support Division can provide assistance with enrollment.
Additional Programs
In addition to the income and asset requirements, there are several programs available through MO HealthNet that may provide additional assistance:
- The Health Insurance Premium Payment (HIPP) Program helps pay for the cost of health insurance premiums for certain MO HealthNet participants.
- Supplemental Nursing Care Program: If you live in a residential care facility or assisted living facility, this program provides a monthly allowance for personal needs and a cash payment to the facility.
- Medicare Cost Savings Programs (QMB & SLMB): These programs can help pay for Medicare premiums and certain copayments.
- Supplemental Aid for the Blind: This program offers a monthly cash grant and MO HealthNet coverage to help blind persons meet their basic needs.
- Blind Pension: Blind Pension offers a monthly cash grant and MO HealthNet coverage to blind persons who do not qualify for help through Supplemental Aid to the Blind or Social Security.
- Show-Me Healthy Babies Program: If you are pregnant and were not approved for coverage through MO HealthNet for Pregnant Women, this program may still be able to provide assistance.
- The Program of All-Inclusive Care for the Elderly (PACE): This program is administered by MO HealthNet and Medicare to provide comprehensive health care, social, recreational, and wellness services to their participants, allowing older adults to live safely in their homes instead of nursing facilities.
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Medicaid long-term care programs
In Missouri, Medicaid is called MO HealthNet. This program offers long-term care support for seniors who cannot afford the care they need. To qualify for Medicaid long-term care, applicants must meet specific eligibility requirements based on income, assets, and medical necessity.
Missouri's Aged, Blind, and Disabled (ABD) Medicaid provides healthcare and long-term care services to financially limited Missouri residents who are aged (65+), blind, or disabled. ABD Medicaid is an entitlement, meaning that anyone who meets the requirements will receive healthcare coverage without waiting. However, access to long-term care benefits through ABD Medicaid depends on the availability of funds, programs, and caregivers in the beneficiary's area.
Missouri's Aged and Disabled Waiver (ADW) provides long-term care services and support to eligible seniors aged 65 and older. Physically disabled Missouri residents aged 63-64 can also receive ADW benefits. ADW program participants must live in their own home or the home of a loved one. Unlike Nursing Home Medicaid, the ADW is not an entitlement and has a limited number of enrollment spots.
The Structured Family Caregiving Waiver (SFCW) is another long-term care program in Missouri. The SFCW provides long-term care services and support to eligible seniors with Alzheimer's disease or related dementias who live with an unpaid caregiver. The caregiver can be a relative, including spouses and legal guardians, or a non-relative. Through the SFCW program, the unpaid caregiver can receive financial support.
Missouri also offers Nursing Home Medicaid, which covers the cost of long-term care in a nursing home for eligible residents who require a Nursing Facility Level of Care (NFLOC). To qualify for Nursing Home Medicaid, applicants must meet specific income and asset requirements.
To apply for Missouri Medicaid, applicants can use the Missouri Medicaid Portal or contact the Family Support Division. Senior Planning organizations can provide assistance in navigating the eligibility requirements and application process.
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Medicaid eligibility criteria
In Missouri, Medicaid is called MO HealthNet. This program provides coverage for low-income children and adults, as well as people with low incomes and low asset levels who are aged, blind, or disabled.
Eligibility Criteria:
To be eligible for MO HealthNet, certain criteria must be met. Firstly, for adults under 65, a household income of up to 138% of the poverty level is required. This equates to a Modified Adjusted Gross Income (MAGI) of $21,597 per year or less for single individuals. If you are 19 or older, your income must be low to qualify, and you must meet at least one of the following conditions: be blind, disabled, or a low-income parent. For blind individuals, the resource limit is $5,909 for singles and $11,818 for couples. If you are disabled, the resource limit is slightly different, with a limit of $5,909.25 for singles and $11,818.45 for couples.
For those under 19, there are three ways to qualify for MO HealthNet. Firstly, MO HealthNet for Kids Non-SCHIP is for children with and without disabilities from low-income families. Secondly, MO HealthNet eligibility extends to young people who work and have earned income. Finally, most people who receive Supplemental Security Income (SSI) also qualify for MO HealthNet.
Additionally, MO HealthNet offers specific programs to assist with nursing home costs. If you reside in a nursing home, MO HealthNet may help cover expenses beyond your personal responsibility. This includes allowing you to keep a $50 monthly allowance and any income set aside for dependents. Furthermore, the Supplemental Nursing Care Program provides a monthly allowance of $50 for personal needs and a cash payment to your facility, with varying amounts for residential and assisted living.
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Medicaid and Medicare
In Missouri, Medicaid is known as MO HealthNet. It is jointly funded by the state and federal government but administered by the state under federally set parameters. MO HealthNet provides coverage for low-income children and adults, as well as individuals with low incomes and low asset levels who are aged, blind, or disabled. The eligibility criteria for MO HealthNet are based on income and asset limits, which vary based on marital status and the specific needs of the individual. For example, in 2025, a single applicant who is blind has an income limit of $1,305 per month, while a married couple with both spouses blind has a limit of $1,763 per month.
MO HealthNet offers a range of services, including coverage for nursing home care, assisted living facilities, and non-medical support services that help seniors remain living in their homes. It also includes managed care health plans, which allow enrollees to choose their primary care provider and change their provider at least twice a year. Additionally, MO HealthNet offers programs such as the Health Insurance Premium Payment (HIPP) Program, which helps pay for health insurance premiums for certain participants.
Medicare, on the other hand, is a federal program that provides health insurance coverage for individuals aged 65 and over. In Missouri, Medicare beneficiaries can receive assistance through Medicaid with the cost of Medicare premiums, co-pays, deductibles, and services that Medicare does not cover, such as long-term care. Medicare products are offered by various companies, including Wellcare by Allwell.
In summary, while Medicaid (MO HealthNet in Missouri) is a state-administered, federal and state-funded program for low-income individuals and families, Medicare is a federal program primarily serving those aged 65 and over. Both programs provide essential health coverage, with some overlap in the form of supplemental support offered by Medicaid to Medicare beneficiaries.
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Medicaid and private insurance
In Missouri, Medicaid is called MO HealthNet. It is jointly funded by the state and federal governments and administered by the state under federally set parameters. MO HealthNet provides health coverage for low-income persons of all ages, including children and adults, and people who are aged, blind, or disabled.
MO HealthNet offers a range of services, including nursing home coverage and assisted living services. For those who qualify, MO HealthNet can help pay for nursing home costs, with beneficiaries required to contribute most of their monthly income towards these costs. There is also a Supplemental Nursing Care Program that provides a monthly allowance for personal needs and a cash payment to the facility.
Medicaid can be used alongside private insurance as a secondary insurance in Missouri. Many Medicare beneficiaries receive assistance through Medicaid for costs not covered by Medicare, such as premiums, co-pays, deductibles, and long-term care. The Health Insurance Premium Payment (HIPP) Program assists with the cost of health insurance premiums for certain MO HealthNet participants.
To enrol in MO HealthNet, individuals can apply online directly through the program or with assistance from the Missouri Department of Social Services Family Support Division. Eligibility is determined through HealthCare.gov, and if eligible, individuals will complete their enrolment with MO HealthNet. It is important to note that eligibility criteria for Medicaid in Missouri change annually and vary based on factors like marital status, income, and health conditions.
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Frequently asked questions
Yes, you can use Medicaid as a secondary insurance in Missouri. In Missouri, Medicaid is called MO HealthNet. It is jointly funded by the state and federal government and administered by the state under federally set parameters.
Medicaid in Missouri is available to low-income children and adults, and to people with low incomes and low asset levels who are aged, blind, or disabled. The American Council on Aging offers a free and easy Medicaid Eligibility Test for seniors.
You can enroll in MO HealthNet online, by phone, or by submitting a paper application.
