Jeffrey Wade
Medicaid in Missouri is called MO HealthNet and is available to low-income children and adults, and to people with low incomes and low asset levels who are aged, blind, or disabled. Enrollment can be done online, by phone, or by submitting a paper application. There are multiple pathways towards eligibility, and the criteria change annually and vary with marital status. If you are approved for help, you will have healthcare coverage through Missouri Medicaid (MO HealthNet). This healthcare coverage is different from Medicare and can help with benefits not normally covered by that program, like nursing home care and personal care services.
| Characteristics | Values |
|---|---|
| Name of Medicaid in Missouri | MO HealthNet |
| Who is eligible for MO HealthNet? | Low-income children and adults, people with low incomes and low asset levels who are aged, blind, or disabled, and adults under 65 with a household income up to 138% of the poverty level |
| How to apply for MO HealthNet | Enroll online directly through the MO HealthNet website, or by phone at 1-800-318-2596 |
| Additional benefits | Home State Health members are covered in the event of a medically necessary emergency and hospital care. They also provide healthcare coverage for the first year of a baby's life, for both mother and child. |
| Other programs | Ticket to Work, Home & Community Based Services, Supplemental Nursing Care Program, Medicare Cost Savings Programs, Supplemental Aid for the Blind, Blind Pension, and more |
| Missouri's stance on Medicaid expansion | Opposition to Medicaid expansion among Missouri's legislative leadership has remained strong |
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What You'll Learn
Medicaid eligibility and enrollment
Medicaid in Missouri is called MO HealthNet. It is a healthcare program for low-income persons of all ages. Coverage is available to low-income children and adults, and to people with low incomes and low asset levels who are aged, blind, or disabled.
Eligibility
To be eligible for MO HealthNet, adults under 65 years of age must have a household income of up to 138% of the poverty level. Infants under one year of age are eligible if their household income is up to 201% of the poverty level. Children aged 1-18 are eligible if their household income is up to 155% of the poverty level. Pregnant women are eligible if their household income does not exceed 201% of the poverty level. Parents with dependent children are eligible with household incomes up to 18% of the federal poverty level (FPL).
Additionally, Missouri offers specific programs for certain groups. For instance, the Blind Pension program offers a monthly cash grant and MO HealthNet coverage to blind persons who do not qualify for help through Supplemental Aid for the Blind or Social Security. The Ticket to Work program helps disabled individuals with their healthcare costs if they make too much money to qualify for MO HealthNet. The Supplemental Nursing Care Program provides a monthly allowance and cash payment to individuals living in residential care or assisted living facilities.
Enrollment
You can enroll in MO HealthNet online, by phone, or by submitting a paper application. To begin the eligibility determination process, you can use HealthCare.gov or call 1-800-318-2596. If eligible, your information will be sent to MO HealthNet, where you will complete your enrollment.
Additional Information
It is important to note that not meeting all the criteria does not necessarily mean one is ineligible for Medicaid in Missouri. There are also specific rules and considerations for long-term care programs, such as the Medicaid Look-Back Rule, which checks for any assets that were gifted or sold under fair market value during the five years preceding one's application.
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Benefits of Medicaid
Medicaid in Missouri is known as MO HealthNet. It provides healthcare coverage to low-income children and adults, as well as individuals with low incomes and low asset levels who are aged, blind, or disabled. MO HealthNet offers benefits that are not typically covered by Medicare, such as nursing home care and personal care services.
MO HealthNet has two types of programs: Managed Care and Fee-For-Service. The Managed Care program includes health plans like Healthy Blue, United Healthcare, and Home State Health. The specific plan an individual receives depends on their age and eligibility. The Fee-For-Service program is for individuals who do not qualify for the Managed Care program.
MO HealthNet provides a range of benefits to its members. For instance, it covers medical emergencies and hospital care for eligible members and their families. It also offers a complete range of medical screening benefits, including dental screenings and immunizations for children. Additionally, MO HealthNet provides programs for specific health issues, such as the Asthma Waves Program, which offers treatment and control of asthma symptoms, and the High-Risk Pregnancy Program, which assists mothers with a history of premature births.
MO HealthNet also offers supplemental programs to assist with other needs. For instance, the Supplemental Nursing Care Program provides a monthly allowance for personal needs and helps cover the cost of living in a residential care facility or assisted living facility. There is also a Ticket to Work program for disabled individuals who earn too much to qualify for MO HealthNet but still need assistance with healthcare costs.
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Applying for Medicaid
In Missouri, Medicaid is called MO HealthNet. It is a healthcare coverage program that is different from Medicare and can help with benefits not normally covered by Medicare, such as nursing home care and personal care services. 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.
How to Apply for Medicaid in Missouri
There are several ways to enroll in MO HealthNet: online, by phone, in person, or by mail.
- Online: You can apply online at https://mydss.mo.gov/healthcare/apply. The website has applications available in English, Spanish, Bosnian, and Vietnamese. You can also complete and submit a paper application by printing it from the website.
- By Phone: Call 1-855-373-9994 or 1-855-373-4636 to apply by phone or request assistance with your application.
- In Person: Apply in person at your local Family Support Division Office.
- By Mail: Call 1-888-275-5908 to request a mailed application or print the application from the website. Mail the completed application to: MO HealthNet Service Center, 525 Jules Street #127, St.
Information to Have Ready
- Social security numbers
- Proof of income (pay stub, federal income tax form, etc.)
- Immigration status
- Written medical proof of pregnancy and expected date of delivery, if applying for MO HealthNet Managed Care for pregnant women
- MRT Packet, if applying for MO HealthNet based on disability
- IM-60A form completed by a psychiatrist or licensed clinical psychologist, if applying for MO HealthNet based on disability
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Long-term care programs
In Missouri, Medicaid is known as MO HealthNet. This program provides long-term care support for seniors who cannot afford the care they need. To qualify for Medicaid long-term care, applicants must be Missouri residents and either US citizens or have proper immigration status. They must also meet the age requirement of 65 years or older, or be blind or disabled.
Missouri Medicaid offers long-term care through three programs: Nursing Home Medicaid, HCBS Waivers, and ABD (Aged, Blind, and Disabled) Medicaid. These programs are different from regular Medicaid, which is available for low-income people of all ages. ABD Medicaid, also referred to as state Medicaid or regular Medicaid for seniors, provides healthcare and long-term care services to eligible Missouri residents who are aged, blind, or disabled. It is an entitlement, which means that anyone who meets the requirements will receive healthcare coverage without having to wait.
The Aged and Disabled Waiver (ADW) is one of the HCBS Waivers in Missouri. It provides long-term care services and support to eligible seniors aged 65 and older, as well as physically disabled residents aged 63-64. ADW 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.
Another HCBS Waiver in Missouri is the Structured Family Caregiving Waiver (SFCW). This program provides long-term care services and support to eligible seniors with Alzheimer's disease or related dementias who live with an unpaid caregiver in a private residence. The caregiver can be a relative or a non-relative, including spouses and legal guardians. Through the SFCW program, the caregiver can receive financial support and become employed and paid by a Structured Family Caregiving provider agency enrolled with the Missouri Department of Social Services.
Missouri Medicaid applicants and recipients who demonstrate a medical need for long-term care benefits can access these benefits through four programs: Home and Community-Based Services, which covers long-term care in a senior's home or the home of a loved one; 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; ABD Medicaid, as described above; and the Medically Needy Pathway, which allows seniors with income over the Medicaid limit to become income-eligible for Medicaid services by "spending down" their income on medical expenses.
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Medicaid expansion
Missouri's Medicaid program, called MO HealthNet, covers low-income children and adults, people with low incomes and low asset levels who are aged, blind, or disabled, and parents who earn less than $3,626 annually. Women typically lose Medicaid coverage after giving birth, and single adults without children are not eligible for Medicaid, regardless of their income.
In 2019, Washington University backed the Healthcare for Missouri initiative, an effort to expand the state's Medicaid program to cover more Missourians. The ballot initiative was passed in 2020, and Medicaid expansion took effect in 2021. However, in June 2021, a circuit court decision put the expansion in limbo as the legislature excluded expanded coverage from its fiscal year 2022 budget. The state Supreme Court heard oral arguments in the appeal on July 13, 2021, and a decision was pending as of July 23, 2021.
If the Medicaid expansion does not proceed, nearly 127,000 uninsured non-elderly adults who fall into the coverage gap will remain ineligible for coverage. These adults have incomes above Missouri's current Medicaid levels but below the minimum eligibility for tax credits through the ACA marketplace. Expanding Medicaid would ensure that these individuals could access basic and life-saving medical care, as evidenced by the experiences of other states that have expanded their programs.
Additionally, expanding Medicaid in Missouri would bring economic benefits, including the creation of thousands of new jobs and increased state revenues. It would also help rural areas, where the uninsured rate is higher than in urban areas, and where hospital closures have been a concern. The additional federal funding would offset some of the state's Medicaid costs, allowing Missouri to redirect funds to infrastructure or education needs.
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Frequently asked questions
Medicaid insurance in Missouri is called MO HealthNet.
You can enroll online directly through the MO HealthNet website. You can also call 1-800-318-2596 or submit a paper application.
MO HealthNet covers benefits not normally covered by Medicare, like nursing home care, personal care services, and personal needs allowances for those in residential care facilities or assisted living facilities.
MO HealthNet is available to low-income children and adults, and to people with low incomes and low asset levels who are aged, blind, or disabled.
If you make too much money, you may still be eligible for MO HealthNet coverage if you agree to pay or "spend down" a certain amount. Once you spend this amount, you will have MO HealthNet coverage for the month.
