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Residents of Missouri who cannot afford medical care or do not have access to health insurance can apply for Missouri HealthNet, the state’s Medicaid program. The state and federal governments jointly fund this comprehensive program, which ensures low-income residents get the healthcare services they need. This guide is a general overview of the program and explains who can apply for Missouri Medicaid benefits, how to access services, and what the program does and does not cover.
Missouri HealthNet is only available to Missouri residents who meet the income and eligibility guidelines set by the state’s Family Services Division (FSD).
Affordable healthcare is a concern for everyone, especially low-income families. In Missouri, more than 30% of families fall into that category, which is higher than most other states, making access to low-cost medical benefits an even greater priority. Missouri HealthNet, the state’s Medicaid program, fills this gap for those who would not otherwise be able to pay for vital healthcare services.
Our guide aims to help you understand Missouri’s Medicaid program, explain what MO HealthNet coverage is, and highlight what you can expect when you apply and enroll. In addition to detailing how the program works and what it covers, you’ll learn about the eligibility requirements, how to apply, and how to use and maintain your benefits. You can use this information to determine the best way to secure health coverage for yourself and your family and assess whether you need extended or private health insurance for additional expenses the state program doesn’t cover.
Missouri HealthNet is the name for Medicaid in Missouri. Every state offers its version of Medicaid in cooperation with the federal government. The programs give qualifying residents access to free or low-cost healthcare that they wouldn’t otherwise be able to pay for on their own. Qualifying individuals can receive free medical services and prescriptions from Missouri HealthNet. The program includes everything from annual physicals and chronic disease management to emergency surgery and dental and vision care for all ages. When members of Missouri HealthNet visit a participating healthcare provider, they present their membership card like any other insurance plan. The provider then bills the state for reimbursement. Members don’t receive any money or payments when they have Missouri Medicaid.
Most Missouri HealthNet enrollees receive their healthcare services through a managed care plan. These programs make healthcare more efficient and increase quality for participants while keeping the costs in check. If you receive approval for MO HealthNet for Families, MO HealthNet for Kids, MO HealthNet for Pregnant Women, the Children’s Health Insurance Program (CHIP), or Show Me Healthy Babies or are eligible adults between ages 19 and 64 and do not have a disability, FSD will assign you to one of the following managed care programs:
By law, each of these programs must provide the same benefits and services to members; the income guideline for the MO HealthNet United HealthCare Community Plan is the same as for Healthy Blue and Home State Health plans. The major difference between them is the network of providers; not all doctors belong to every program, so you need to confirm that your doctor participates in the program. Otherwise, you will need to find a different doctor who belongs to the program.
When you do not qualify for the MO HealthNet Managed Care Program, you may receive healthcare through a traditional fee-for-service program. With this option, you do not have to have a primary care provider and can see any doctor who accepts MO HealthNet.
Missouri Medicaid covers the lion’s share of healthcare costs for enrollees, but some members pay nominal copayments for services. The copayment for inpatient hospital services is $10; other copayments range from 50 cents to $3. Vision, dental, and podiatry service copayments range from 50 cents to $3 based on the total cost of the services.
Managed Care program participants do not have copayments. Other groups and services that don’t require payment at the time of service include:
When the Family Support Division (FSD) approves your application for Missouri Medicaid, you’ll receive an identification card. If applicable, the MO HealthNet managed care plan will also send you a member ID card. You’ll need to bring both cards with you whenever you seek healthcare services. Your Missouri medicaid card will feature your name, your identification/plan number and sometimes your date of birth. It’s important to also carry photo identification because medicaid cards do not include your photo.
Individuals over 65 who receive Medicare benefits will also receive a card from that program with their plan ID information. You will also need to bring this card with you to doctor’s appointments.
To access MO HealthNet benefits, you must apply through the FSD.
There are four options to do this: online, in person at your local Department of Social Services (DSS) office, or via phone, fax, or email. If you fall into any of the following groups, you must submit a Supplemental Form in addition to the Medicaid application:
Before you apply for Medicaid, gather the following information:
If you don’t have all the required information, you can still sign and submit the application, and a FDS representative will follow up with you to collect the missing details. The department requires documentation of the information you submit on the application, which you can do when you apply online.
It may take several weeks to process your application and approve your MO HealthNet benefits. You should hear from FDS about the status within 45 days. When approved, you’ll receive a letter and an MO HealthNet card by mail, along with information and instructions on how to use the benefits.
Like every state, only people who meet the state’s criteria for benefits can enroll in Missouri HealthNet. Household income is the most important factor, but your age, family size, and, in some cases, health status determine whether you qualify.
In general, to qualify for MO HealthNet coverage, you must meet the following criteria:
Missouri uses the IRS’s Modified Adjusted Gross Income (MAGI) calculation to determine who is eligible for healthcare assistance through the Medicaid program. Except for the Children’s Health Insurance Program (CHIP), household gross income cannot exceed the MAGI for your household size, which is 194% of the federal poverty level guidelines (206% for CHIP).
Low-income seniors who receive Medicare can also apply for MO HealthNet. Although everyone who pays Medicare taxes during their careers can access Medicare when they turn 65 regardless of income, Missouri can provide additional assistance and healthcare coverage through Medicaid. The state will cover some or all costs of Medicare premiums for seniors with incomes less than the established limits.
Upon approval for Missouri Medicaid, FDS will mail you an MO HealthNet card and information about your new health coverage. You’ll receive a separate package about your Managed Health Plan options and how to choose a primary care provider.
Once you enroll in Missouri Medicaid, you can receive benefits as long as you’re eligible. To maintain MO HealthNet coverage, you must renew your benefits every year. This renewal usually takes place on the anniversary of your enrollment date.
To renew benefits, you’ll submit updated documentation of your circumstances. Although Missouri did not require MO Health members to renew Medicare benefits during the pandemic, renewals started again on April 1, 2023. Not submitting the required information by the deadline may result in losing benefits.
If your circumstances change before your renewal date, the state requires you to report them immediately. Moving, getting a new job, changes to your family size, or increases in your income are some things you need to tell FDS.
When you need a new card to replace a lost, damaged, or stolen one, call the FDS for a replacement MO HealthNet card at 1-800-997-7777 or begin the process online by following this link. If you need a new managed health plan card, call the plan directly to request it.
Healthcare benefits under Missouri Medicaid are comprehensive and cover most of the health services the average person needs. These include the following:
Missouri Medicaid recipients can also access non-emergency medical transportation to appointments. Members of Managed Care Plans also have access to a 24-hour nurse-staffed hotline.
All children who qualify for Medicaid benefits can receive dental care from MO HealthNet dental providers, but benefits vary for adults. For kids, coverage includes basics like checkups and cleanings, sealants, infection treatment, pain relief, tooth restoration, fillings, crowns, extractions, root canals, and emergency dental care. With Medicaid benefits, adults are also covered for the following dental treatments:
While the dental coverage that Missouri Medicaid provides is comprehensive, it does come with its limitations. For those who have more serious dental issues and anticipate requiring more visits to the dentists, investing in private dental plans in Missouri is advisable.
While Medicaid plans do not have to cover prescription drugs, Missouri provides this optional coverage. MO HealthNet’s pharmacy program offers beneficiaries most prescriptions for a low copayment of just a few dollars.
MO HealthNet maintains a preferred drug list of approved medications for Medicaid enrollees. If a doctor prescribes a medication that isn’t on the list, they can seek pre-authorization to ensure you get the prescription you need with your Medicaid benefits.
Also, MORx, a prescription drug assistance program, enhances accessibility to essential medications, ensuring affordable healthcare for eligible Missourians. By subsidizing prescription costs, MORx plays a pivotal role in promoting health equity and alleviating financial burdens associated with necessary medications.
Missouri Medicaid also covers vaccinations for children, either at their doctor’s office or a public health clinic. The federal Vaccines for Children program reimburses health care providers for vaccines administered to eligible children.
MO HealthNet provides Medicaid recipients with extended healthcare benefits to help them live healthy lives. Routine checkups and basic medical treatments will only get you so far. Many patients require additional care, but they go without because of financial concerns, lack of coverage, and restricted access. Investing in quality disability insurance is an excellent way to assist with some of the costs incurred with not being able to work either temporarily or permanently, and to help with the cost of medical needs.
On top of coverage for prescription drugs and dental work, Missouri Medicaid also covers extended health care services.
Here are some examples of extended health care available through Missouri Medicaid:
If you plan to travel outside Missouri, be aware that your Medicaid benefits will not cover medical care in other states. The benefits aren’t universal because every state has unique Medicaid eligibility requirements and programs. If you seek treatment outside Missouri for anything other than a life-threatening emergency, you will have to find a way to cover the costs on your own if you do not seek pre-approval for the care.
MO HealthNet members can seek treatment from providers in bordering states (Arkansas, Illinois, Iowa, Kansas, Kentucky, Nebraska, Oklahoma, and Tennessee) who are network members without seeking pre-approval.
Beyond those borders and most definitely out-of-country, invest in proper travelers insurance.
The Affordable Care Act guarantees that college students and young adults can remain on their parents’ insurance policies until age 26. MO HealthNet does not cover adults without children, so if you’re over 19 and do not have children, you must find alternative insurance from an employer, your college or university, the federal insurance marketplace, or a private insurer.
Adults over 65 can enroll in Medicare, a federal entitlement program with no income requirements. Medicare Parts A and B cover some medical services with a low monthly premium. Low-income seniors can also qualify for help with those premiums and receive Medicaid benefits through a special needs program.
These programs for seniors include:
Qualifying Missouri seniors can also receive assistance with long-term care expenses through a few MO HealthNet insurance programs, including:
In addition to Missouri Medicaid coverage for adults and seniors, coverage is also extended for children up to age 19 through CHIP, addressing developmental disabilities via the Sara Lopez Waiver. As well, the program provides the Extended Women’s Health Care Waiver ensuring family planning services for eligible women.
Missouri extends Medicaid coverage to children up to age 19 if they or their parents meet the eligibility requirements. Families earning less than 209% of the federal poverty level guidelines for their family size but more than the state Medicaid income limits can apply for the Children’s Health Insurance Program (CHIP) to secure health insurance coverage.
Children with developmental disabilities can receive MO HealthNet coverage via the Missouri Children with Developmental Disabilities (Sara Lopez) Waiver. The difference between MO HealthNet and Medicaid for disabled children is in the eligibility requirements: Children need certification from the Department of Mental Health and must have an income of less than $1,598 and available assets of less than $5,726 to qualify.
Federal law requires state Medicaid programs to cover family planning services, including sexually transmitted infection (STI) screening and treatment and prescription birth control. However, women in Missouri who do not qualify for full Medicaid or are about to lose Medicaid benefits 60 days after giving birth can apply for an Extended Family Planning Waiver. This fully state-funded program covers women’s health and family planning services for women with household incomes less than 206% of the federal poverty level.
Missouri offers some of the most generous Medicaid benefits in the country, but that doesn’t mean it covers everything. Some services that the plans do not cover include:
Missouri medicaid may assist with some of the costs of burials or cremations, but not all. Considering the rising cost of funerals and related fees, ensure that your family is secured with comprehensive funeral insurance.
The federal government has rules dictating that states provide certain benefits, but there is still a great deal of leeway and variation among the states when it comes to the specifics. The following list doesn’t include everything MO HealthNet covers, but it’s a good overview of the basics.
| Dental | |
|---|---|
| X-Rays and Exams | Yes |
| Tooth Extraction | Yes |
| Cleanings | Yes |
| Office Visits | |
|---|---|
| Primary Care Visits | Yes |
| Preventive Care | Yes |
| Annual Physical | Yes |
| Routine Lab Work and X-rays | Yes |
| Vision | |
|---|---|
| Eye Exams | Yes |
| Glasses | Yes |
| Surgery | |
|---|---|
| Emergency Surgery | Yes |
| Transplant Services | Yes |
| Rehabilitation Services | Yes |
| Hospital | |
|---|---|
| Inpatient Hospital Stays | Yes |
| Outpatient Hospital Services | Yes |
| Labor and Delivery | Yes |
| Emergency Room Services | Yes |
| Sexual Health | |
|---|---|
| Gynecologist Visits | Yes |
| Family Planning | Yes |
| Prenatal Care | Yes |
| Specialist Services | |
|---|---|
| Chiropractor | Yes |
| Alternative and Complementary Medicine | Yes |
| Massage Therapy | Yes |
| Dialysis | Yes |
| Podiatry | Yes |
| Durable Medical Equipment and Supplies | Yes |
| Hospice Service | Yes |
| Home Care Services | Yes |
| Transportation | |
|---|---|
| Ambulance Services | Yes |
| Non-emergency Medical Appointment Transportation | Yes |
Again, while the Missouri Medicaid program is generous and covers the most critical healthcare services, it does have some gaps. If you need additional vision coverage, for example, or want more flexibility in your choice of providers, you might need to invest in third-party supplemental health insurance. Other types of private insurance, such as life insurance, can help pay for medical costs Medicaid will not cover, especially in the event of your passing.In particular, Medicare beneficiaries with Medicaid often need extra insurance to cover the costs of complex, ongoing health needs that the state and federal governments don’t cover.
Purchasing extended coverage when you have Medicaid benefits provides the extra peace of mind that an unexpected illness or injury won’t lead to financial ruin. These include:
If you need help making sense of MO HealthNet for families and whether you need more health insurance, Insurdinary can help. We make it easy to find the perfect plan.
Get the insurance policy that best fits your budget and healthcare needs when you compare MO Medicaid and private insurance options with help from Insurdinary. Request free quotes from local insurance carriers today using our fast and easy tool.
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