MO HealthNet

The Medicaid program in Missouri is called MO HealthNet, and offers health insurance to several groups of low-income residents. Qualifying residents have access to many medical services, including hospital care, physician services, emergency room visits, and anything your specific condition may require. Families, pregnant women, and children with low income may be eligible for coverage through the program if they meet the income guidelines. Those who are aged, blind, or disabled also may be eligible within certain income limits.

Recipients of Supplemental Security Income are automatically enrolled in MO HealthNet, and those in other public programs such as Nursing Care, Home and Community Based Services, Blind Pension, and Supplemental Aid to the Blind also have automatic access to MO HealthNet coverage. In addition to covering medical services for regular health concerns, MO HealthNet provides maternity coverage, supplies and care for those with special health needs, and therefore is one of the most inclusive health insurance plans available. Services are available for free or a low copay for certain types of care.

 

MO HealthNet Eligibility

Based on your income and other factors, the Missouri Department of Social Services will evaluate if you are a good fit for the program. Requirements are judged according to income criteria specific to each eligibility category. You must also be a U.S. citizen or legal resident of the country, be uninsured, and live in Missouri to qualify. If you have access to any other type of health insurance, you will be disqualified. This includes COBRA, group plans, and temporary coverage in the past six months.

Income guidelines are based according to your family size and total income earned in your household.

 

Current Federal Poverty Level

 

Pregnant Women & Infants 185%

Family of 2: $2,333 monthly, $27,991 yearly

Family of 3: $2,943 monthly, $35,317 yearly

Family of 4: $3,554 monthly, $42,643 yearly

Family of 5: $4,164 monthly, $49,969 yearly

 

Children Ages 1-5 133%

Family of 1: $1,238 monthly, $14,856 yearly

Family of 2: $1,639 monthly, $19,699 yearly

Family of 3: $2,068 monthly, $24,817 yearly

Family of 4: $2,497 monthly, $29,965 yearly

 

Children Ages 6-19  100%

Family of 1: $938 monthly, $11,170 yearly

Family of 2: $1,260 monthly, $15,130 yearly

Family of 3: $1,590 monthly, $19,090 yearly

Family of 4: $1,920 monthly, $23,050 yearly

 

Parent (unemployed) 19%

Family of 1: $177 monthly, $2,122 yearly

Family of 2: $240 monthly, $2,874 yearly

Family of 3: $302 monthly, $3,627 yearly

Family of 4: $365 monthly, $4,380 yearly

 

Parent (employed) 36%

Family of 1: $335 monthly, $4,021 yearly

Family of 2: $454 monthly, $5,447 yearly

Family of 3: $573 monthly, $6,873 yearly

Family of 4: $692 monthly, $8,298 yearly

 

Aged, Blind, or Disabled 85%

Single: $791 monthly, $9,495 yearly

*$1,000 Asset Limit

Couple: $1,071 monthly, $12,860 yearly

*$2,000 Asset Limit

 

Qualified Medicare Beneficiaries (QMB) 100%

Medicaid covers your premiums, coinsurance, and deductibles.

Single: $938 monthly, $11,170 yearly

Couple: $1,260 monthly, $15,130 yearly

 

Specified Low-Income Medicare Beneficiaries (SLMB) 120%

Medicaid covers your premiums only.

Single: $1,117 monthly, $13,404 yearly

Couple: $1,513 monthly, $18,156 yearly

 

 

Covered Benefits

All benefits are subject to the beneficiary and the program in which they are enrolled. Certain services will limited for adults who are not receiving assistance for blindness or pregnancy. Those receiving care through MO HealthNet managed care must seek services from their primary care physician and other providers in their health plan. All necessary services will be provided by the health plan, which is the most common way to obtain MO HealthNet coverage. You may also enroll in MO HealthNet as a fee-for-service member, where you have the ability to choose any participating Medicaid provider in Missouri. Covered services include the following:

 

  • Physician care
  • Inpatient hospital stays
  • Outpatient diagnostic services
  • Outpatient surgery
  • Lab and X-ray
  • Dental care
  • Vision exams and eyeglasses
  • Hearing screenings and hearing aids
  • Preventive care
  • Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) for members under 21
  • Prescription medications
  • Emergency care
  • Ambulance services
  • Podiatry
  • Home health care
  • Personal care and adult day care
  • Durable medical equipment
  • Family planning services
  • Nurse midwife care
  • Nursing home services
  • Rehabilitative services for those with prosthetic devices
  • Transplant procedures
  • Mental health care
  • Substance abuse treatment
  • Clinic services
  • Hospice care
  • Waiver programs for home and community-based care

 

Managed Care

When you enroll in MO HealthNet, most members select a managed care organization to coordinate their care, unless they choose the fee-for-service option. This is the most simplistic and efficient way to receive services. Depending on your region, your MCO choices will vary. Once you choose a health plan, you will also designate a primary care physician to help you with all of your medical needs. In addition to using your MCO’s network of MO HealthNet providers, you may also seek care from a Federally Qualified Health Center or rural health clinic.

Western

Blue Advantage Plus of Kansas City, Inc.

www.bapluskc.com

888-279-8186

*Not available in Bates, Cedar, Polk, or Vernon Counties.

 

HealthCare USA

www.hcusa.org

800-625-7602

 

Missouri Care Health Plan

www.missouricare.com

800-322-6027

 

Molina Healthcare of Missouri

www.molinahealthcare.com

800-875-0679

 

Central

HealthCare USA

www.hcusa.org

800-625-7602

 

Missouri Care Health Plan

www.missouricare.com

800-322-6027

 

Molina Healthcare of Missouri

www.molinahealthcare.com

800-875-0679

 

Eastern

Harmony Health Plan of Missouri

www.harmonyhpm.com

866-822-1340

 

HealthCare USA

www.hcusa.org

800-625-7602

 

Missouri Care Health Plan

www.missouricare.com

800-322-6027

 

Molina Healthcare of Missouri

www.molinahealthcare.com

800-875-0679

 

How to Apply

If you feel you may qualify for MO HealthNet coverage, you can apply online or fill out and mail a paper application to the Missouri Department of Social Services MO HealthNet Division. There are two different applications depending on your eligibility category, and other languages available. If you fall under the category of children, parents, or pregnant women, read these instructions and fill out the application here. For those who are applying in the aged, blind or disabled category, your application is available in print form only.

View all MO HealthNet Applications

 

Resources

MO HealthNet

Apply for MO HealthNet

 

 

 

Sources:

 

1. Missouri Department of Social Services. “MO HealthNet Division”. http://dss.mo.gov/mhd/.