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Medicaid Basics

Medicaid Information and Qualification

What is Medicaid? What is MOHealthNet? Do I qualify for this program? What does Medicaid cover? How do I apply to become a part of this program?

If these questions are similar to what you are wondering, please read further for information regarding Medicaid in Missouri, and how to apply for the MO HealthNet programs.

1. What is Medicaid, and What is MO HealthNet?

Medicaid is a state and federally funded insurance program that exists in every state in the US. However, it differs greatly from state to state, and the Missouri Medicaid program is also called MO HealthNet. The Department of Social Services (DSS) has a Family Support Division (FSD) which determines eligibility for families and individuals, while MO HealthNet handles the payments and finances.

The MO HealthNet program includes two different types of coverage: a fee for service program and a managed care plan. Read further to determine which program you might be eligible for.

Demographically, 64% of Medicaid recipients are 18 years of age of younger, and 22% of MO HealthNet recipients are disabled or blind. 29% of Missouri adults have been diagnosed with some kind of disability, and there are over 78,000 elderly people over the age of 65 who are currently covered by MO HealthNet. The FSD does have 144 locations across the state to assist program members in any county.

Medicaid in Missouri covers low-income children and their parents, guardians, or caretakers. It also covers elderly, blind, or disabled individuals who meet income and resource restriction standards. The services covered by Medicaid in Missouri include, but are not limited to:

  • Outpatient/inpatient services
  • Primary, acute, and preventative care
  • Non-emergent medical transportation
  • Health screenings and immunizations
  • Necessary medical equipment
  • Family planning services
  • Behavioral health and substance abuse services
  • X-ray and laboratory services when prescribed by a physician
  • Nurse-midwife services
  • Physical, occupational, and speech therapy

Some services are only available for certain individuals, and these additional services include:

  • Dental, hearing, and vision care
  • Pharmacy and mental health services
  • In-home care
  • Rehabilitation care
  • Screening and treatment of children under 21 years of age

2. Do I Qualify for Medicaid?

There are certain criteria, specific to Missouri, that are required to qualify for the MO HealthNet program. All Missouri Medicaid applicants must:

  • Reside in Missouri
  • Be a US citizen or an eligible qualified non-citizen
  • Apply for or have a valid social security number
  • Meet the individual program’s income requirements

As previously mentioned, there are two different plans for Missouri Medicaid: the managed care plan, and the fee-for-service model.

The Managed Care Plan:

This plan falls under the MO HealthNet for Families, and covers children 18 or younger, along with their parents, caretakers, or the guardian with which they reside. Single parents must cooperate with Missouri’s Child Support Enforcement (CSE) to gain medical support from the parent who no longer has custody. Pregnant women and newborns can qualify for Medicaid while the woman is still pregnant. If pursued, this coverage includes 60 days of postpartum care and the coverage for the child extends until the first birthday of the child no matter what.

The Fee-For-Service Plan:

This program is designated for seniors on Medicaid. To qualify, seniors must:

  • Be at least 65 years of age
  • Intend to continue living in Missouri
  • Not be a resident of any kind of institution, with the exception of public medical institutions

To qualify for MO HealthNet for People with Disabilities, an individual must be permanently and totally disabled in accordance with the qualifications defined by the Social Security Administration; they must be unable to gain and sustain employment for a year or longer due to a disability, either physical or mental. They must also not be a member of a public institution.

The income criteria for MO HealthNet programs is determined by poverty guidelines that the federal government is responsible for setting. Resources criteria can also be set, which includes assets such as savings and other countable assets; however these resources typically only apply to the elderly, disabled, and blind applicants.

3. Do I meet the income limit for Medicaid in Missouri?

The income requirements vary by program. Income counted for review includes employment wages, social security payments, pension and alimony payments, stock dividends, and IRA withdrawals. To qualify for the plan for Seniors and People with Disabilities, the requirements are:

  • Assets valued at less than $2000 is single, and less than $4000 if married and reside with their spouse
  • Net household income of less than $834 if single or $1129 if married
  • Income less than $16,612 for a 1 person household, less than $5,878 per person for households 8 or larger

Assets are reviewed 5 years prior to the application date, to ensure there are no transfers of assets to date. If an individual’s assets exceed the maximum allowable amount, then those will need to be spent before a person can begin coverage.

If your monthly income exceeds the above mentioned amounts, you may become eligible when your incurred medical expenses reduce your monthly income below this limit (i.e. when you meet your spenddown).

4. Do I have to pay for MO HealthNet?

Medicaid is free for most programs. The only reason a member would need to pay for the Seniors and Disabled plan would be if a person didn’t meet the minimum income requirements, but still qualified for a spenddown. A spenddown is an expenditure limit on medical services. Once reached, Medicaid coverage will begin for the person with the spenddown and their further services will be covered by Medicaid for that month. Spending down can include:

  • A monthly submission of medical expenses to a caseworker
  • Monthly payments of the spend down amount to the MO HealthNet Division (these payments would act similarly to paying an insurance premium)

5. Will I have to wait long to get approved for my Medicaid coverage?

Typically, applications take 30-45 days to process, but the wait could be as long as 90 days depending on other factors. By ensuring your application contains complete and accurate information, you can ensure the quickest possible turn-around time.

If you are applying for Medicaid and you need your assets to be reviewed and appraised, this process can take extra time and might delay the processing speed of the application.

6. How do I apply for Medicaid?

Residents of Missouri can sign up for Medicaid online, by phone, by mail, or in person at a Medicaid office. It is important that an applicant checks they qualify and have the required documents before applying. The required documents, along with an application form, include:

  • Proof of US citizenship
  • Proof of Missouri residency
  • Income statements
  • Social security number
  • Current address
  • Phone number
  • Household size by person

If an individual is applying for other family members, they must submit this information for every family member for which they are applying. This includes a separate Medicaid application for each family member. When filling out applications, it is important to be thorough and fill out all important information and dates correctly and accurately. Mistakes in this process could result in later delays in processing, or denial of admittance into the Medicaid program.

If you choose to apply in person or over the phone, a representative can help walk you through the process which may be helpful to some applicants. In Medicaid FSD offices, there are forms available in English, as well as Spanish, Vietnamese, and Bosnian. If your native language is not included in these, an office representative will be available to assist you.

7. What are the different waivers available with Medicaid?

Waivers offered by Medicaid provide long-term care for those who are elderly or disabled, and allow them to live in the community to receive care rather than in a nursing facility or institution. The state prefers this process because institutionalized care is often far more expensive than home care. There are three main Home and Community Based Services (HCBS) waivers offered by the state:

  • The Aged and Disabled Waiver (ADW) provides in home services to seniors requiring a nursing home level of care. This program includes respite care, chore services, adult day care, home meals delivered, and homemaker services. This program does have limited spots available at any given time.
  • The Supplemental Nursing Care (SNC) provides financial assistance to those living in residential care facilities including assisted living.
  • The Independent Living Waiver (ILW) is commonly used for physically disabled adults enrolling under the age of 64 to be able to continue to receive services. Some available benefits include personal care assistance, home modifications, and medical equipment and supplies. This waiver is popular with CDS program members because it allows for additional service hours of self-directed care by a person of the applicant’s own choosing. This includes family members excluding spouses, or a friend.

8. I have applied, but what do I do now?

Applications take several weeks to process, and it is not uncommon for the state to require additional information or documentation after they have received your application. If this is the case, they will contact you by phone, mail, or email, depending on how you submitted your application, to inquire about the additional information. If you are curious about the status of your application, you can contact MO HealthNet online, or by phone at 1-888-275-5908.

Sources:

Eligibility Team. “Missouri Medicaid Eligibility Help.” Eligibility, 23 June 2020, eligibility.com/medicaid/missouri-mo-medicaid-benefits.

Linda, Li, et al. “MO Medicaid Demographics and Work Requirement.” WashU Center for Health Economics and Policy, Mar. 2018, publichealth.wustl.edu/wp-content/uploads/2018/03/MO-Medicaid-Demographics-and-Work-Requirement.pdf.

“Medical Services: MO HealthNet for Families, Kids, Pregnant Women and Newborns.” Missouri Department of Agency, mydss.mo.gov/msmcp#:~:text=dental%2C%20hearing%20and%20vision%20care,non%2Demergency%20medical%20transportation%20*%3B.

Interested in Switching Providers?

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Am I Eligible?

CDS is a Medicaid-funded program that enables you to hire the caregiver of your choice to help with daily activities. If you meet the below criteria you may be eligible for CDS:

  • Have Medicaid
  • Live in Missouri
  • Need help with day-to-day activities
  • Able to direct your own care

Fill out this form and we'll be in touch!

Am I Eligible?

CDS is a Medicaid-funded program that enables you to hire the caregiver of your choice to help with daily activities. If you meet the below criteria you may be eligible for CDS:

  • Have Medicaid
  • Live in Missouri
  • Need help with day-to-day activities
  • Able to direct your own care

Already have CDS? You can switch today!?

Fill out this form and we'll be in touch!