Medicaid Eligibility in MissouriUpdated November 9, 2017 Medicaid
Medicaid is a federal- and state-funded health insurance program that works for low-income individuals, families, and seniors who otherwise wouldn’t be able to afford health care coverage. Missouri’s Medicaid program, which is known as MO HealthNet, runs through the Missouri Department of Social Services.
Missouri’s Requirements for Medicaid Qualification
Missouri offers two different types of MO HealthNet (Medicaid) coverage — a managed care plan and a fee-for-service program. The type of coverage you’re eligible to apply for depends on your personal situation and needs.
All Medicaid applicants in Missouri must:
- Reside in Missouri
- Be U.S. citizens or eligible qualified non-citizens
- Apply for or have a valid social security number
- Meet the individual program's income requirements
Managed Care Plan Requirements:
The MO HealthNet for Families covers children under the age of 19 and their parents, caretakers, or relatives with whom they live. However, single parents must agree to cooperate with the state’s Child Support Enforcement (CSE) in the pursuit of medical support from the non-custodial parent.
Eligible pregnant women and newborns qualify for Medicaid coverage during the mother’s pregnancy. The mother’s coverage includes 60 days of postpartum care and the child’s coverage extends for one year after the birth, regardless of increases in the family’s income.
Fee-for-Service Program Requirements:
To qualify for the MO HealthNet for Seniors program, seniors must be:
- At least 65 years old
- Intend to continue living in Missouri
- Not be a resident of a public, private, or endowed institution unless it’s a public medical institution
- To qualify for the MO HealthNet for People with Disabilities, a person must:
- Be permanently and totally disabled as defined by the Social Security Administration — unable to obtain gainful and substantial employment for one year or longer due to a physical or mental disability
- Not be a resident of a public institution, unless it’s a medical institution
- To qualify for the Breast or Cervical Cancer Treatment MO HealthNet program, women must:
- Be uninsured — or have health insurance that doesn’t cover breast and/or cervical cancer treatment
- Be under the age of 65
- Have had a DHSS Show Me Healthy Women screening that resulted in a diagnosis of breast and/or cervical cancer
- Have a need for breast or cervical cancer treatment
- Intend to remain living in Missouri
- To qualify for the Uninsured Women’s Health Services program, women must be:
- Between the ages of 18 and 55
- In need of family planning services
- Uninsured or have no access to an employer-sponsored health insurance program that offers family planning services
- Ineligible for any other MO HealthNet Medicaid program
- To qualify for MO HealthNet for the Blind and Visually Impaired people must:
- Be age 18 or older
- Be legally blind — have vision less than 5/200
- Intend to remain living in Missouri
- Not have a sighted spouse who can provide support
- Not publicly solicit alms
- Not be a resident of a public institution unless it’s a medical institution
How to Apply for Medicaid in Missouri
Apply for Medicaid online by visiting the Missouri Department of Social Services' website or apply in person at your nearest Department of Social Services office. While you can’t apply for Medicaid over the phone, you can call the Missouri Department of Social Services at 1-573-751-3221 to check the status of your application.
Missouri Medicaid Application
The Missouri Medicaid application asked you a series of questions regarding your place of residence, health, level of income, and household members. Applicants also need to provide proof of residence, income, and identity for themselves and all family members, as well as any program-specific documentation required — such as proof of a disability.
What Does Medicaid Cover in Missouri?
Each Medicaid program in Missouri has specific coverage limits — and people who qualify receive a letter explaining what their plan covers.
It’s especially important for people with fee-for-service plans to know which services their plan covers because they all differ. To verify eligibility for a specific service, call the MO HealthNet Participant Services Unit at 1-800-392-2161.
Missouri Medicaid has three different providers within its managed care plan — United Health Care, Home State Health, and MissouriCare. Each program is required to have the exact same services and coverages — so choose your plan based on which option your doctor accepts. The coverages include, but aren’t limited to:
- Primary care services
- Specialty care with a referral from your primary care physician
- Family planning services
- Emergency medical services
- Behavioral health and substance abuse services
Income Requirements for Missouri Medicaid
Missouri Medicaid’s income requirements vary between programs. The program for women in need of breast or cervical cancer treatment is the only Missouri Medicaid program that doesn't have an income limit.
Families who qualify for the MO HealthNet must have a household income lower than the Modified Adjusted Gross Income (MAGI). However, if the family exceeds these requirements, the children may still qualify for one of the two MO HealthNet for Kids Medicaid — SCHIP and Non-SCHIP.
Non-SCHIP provides coverage for children in families that exceed the income limits for family coverage as long as the household income does not exceed:
- 196 percent of the Federal Poverty Level (FPL) for children under age one.
- 148 percent of the FPL for children between the ages of one and 18.
SCHIP provides coverage for uninsured children whose family’s income exceeds the MAGI but is below 150 percent of the Federal Poverty Level (FPL). If your family’s income exceeds 150 percent but is less than 300 percent of the FPL, your children may qualify for one of the state’s premium Medicaid plans.
To qualify for the state’s plan for pregnant women and newborns, your family’s income can’t exceed 196 percent of the FPL for your household size, including the unborn child/children.
To qualify for MO HealthNet for People with Disabilities or Seniors you:
- Can’t own assets valued at less than $2000 if single or less than $4000 of married and living with their spouse.
- Have a net household income of less than $834 if single or less than $1129 if married.
People who are blind or visually impaired can’t have a monthly net income that exceeds $981 for individuals and $1328 for couples.
To qualify for the Uninsured Women’s Health Services Program, your income can’t exceed 201 percent of the FPL for your household size.
How Much Does Medicaid Cost in Missouri?
Most Medicaid plans in Missouri are free. However, some plans — such as the plans for seniors and disabled people — provide health coverage to people who don’t meet the minimum income requirements once their spend down limit for the month is met. Also, the premium SCHIP plans for children have a monthly premium, which is determined based on your family’s monthly income.
Prescription Drugs with Medicaid in Missouri
Prescription drugs are covered by Missouri Medicaid plans. However, the type of prescriptions covered and your out-of-pocket cost depends on the type of plan you have. Check your program's coverage limits and terms to determine the cost of your prescription.
Which Medicaid Plan is Best in Missouri?
Missouri residents don’t have an option to choose from different types of Medicaid plans. Each plan has specific requirements for both eligibility and coverage.