Medicaid in Missouri, or MO HealthNet, is a comprehensive healthcare program providing medical services to eligible low-income residents and families. This program is a joint federal and state initiative designed to assist those with limited income and resources, including children, pregnant women, elderly adults, and individuals with disabilities.

MO HealthNet covers many health services, such as doctor visits, hospital stays, prescription drugs, preventive care, and long-term services and supports.

Eligibility for Medicaid in Missouri is determined based on income, household size, and other factors, with specific guidelines varying for different groups within the population.

The state has periodically reviewed and adjusted its Medicaid program to align with federal guidelines and address the healthcare needs of its residents, including expanding coverage options under the Affordable Care Act.

Through MO HealthNet, Missouri aims to ensure that vulnerable populations have access to necessary healthcare services, thereby improving public health outcomes and reducing health disparities within the state.

Medicaid in Missouri, or MO HealthNet, offers its beneficiaries a broad spectrum of covered services, aiming to provide comprehensive healthcare coverage. Below is an overview of some of the key services covered, along with a brief description of each:

• Doctor Visits: Allows beneficiaries to see a healthcare provider for routine checkups, illness, and preventive care.
• Hospital Services: Covers inpatient and outpatient hospital care, including surgeries, emergency services, and other necessary treatments.
• Prescription Drugs: Provides access to prescribed medications, subject to state formulary guidelines and prior authorization requirements.
• Dental Services: Includes routine checkups, cleanings, extractions, and other dental care for children; adults have limited coverage.
• Vision Care: Covers eye exams and, in some cases, glasses or contact lenses, primarily for children under 21.
• Mental Health Services: Offers counseling, therapy, psychiatric services, and substance abuse treatment to support mental health and well-being.
• Long-Term Services and Supports: Provides care for individuals with chronic illnesses or disabilities, including home health care, nursing home care, and community-based services.
• Pregnancy and Maternity Services: Supports pregnant women with prenatal, childbirth, and postpartum care to ensure healthy outcomes for mother and child.
• Rehabilitative Services: Aims to help individuals recover from an injury or illness, including physical therapy, occupational therapy, and speech therapy.
• Laboratory and X-Ray Services: Covers diagnostic tests and imaging services prescribed by a healthcare provider to help diagnose or treat medical conditions.
• Transportation Services: Offers non-emergency transportation to and from healthcare appointments for eligible beneficiaries, ensuring access to necessary medical care.
• Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services for Children: Provides comprehensive and preventive healthcare services for children under 21, including screenings, immunizations, and necessary treatments to address health issues early.

Each of these services is subject to specific eligibility criteria, coverage limitations, and prior authorization requirements as defined by MO HealthNet policies.

Eligibility for MO HealthNet is determined based on various factors, including income, household size, and specific individual circumstances. Below are the key eligibility requirements for different groups within the population:

1. Income Limits: Eligibility is primarily income-based, with limits varying by group. For example, children, pregnant women, and families with children often have higher income eligibility thresholds than other groups.
2. Household Size: The size of the applicant's household affects the income limit for eligibility. Generally, larger households have higher income thresholds.
3. Age and Status: Specific programs target different age groups and statuses, such as children, pregnant women, elderly adults, and individuals with disabilities.
4. Residency and Citizenship: Applicants must be Missouri residents and U.S. citizens, legal permanent residents, or legal aliens.
5. Children and Families: Families with children under 19 may qualify for coverage if they meet income and residency criteria.
6. Pregnant Women: Pregnant women can qualify for MO HealthNet coverage if they meet income guidelines, which are more lenient compared to other groups to ensure prenatal, birth, and postnatal care.
7. Elderly and Disabled: Individuals 65 years or older, blind, or disabled according to Social Security standards may qualify based on income and asset tests.
8. Medically Needy Pathway: This option allows individuals whose income is too high for standard Medicaid to "spend down" by deducting certain medical expenses to meet eligibility criteria.
9. Children in Foster Care or Adoption: Children in foster care or adopted may qualify for Medicaid regardless of the adoptive parent's income.
10. Breast and Cervical Cancer Program: Women diagnosed with breast or cervical cancer through a CDC screening program may qualify for Medicaid.

These are general guidelines, and specific eligibility criteria can change. Missouri periodically updates its Medicaid eligibility requirements in response to federal guidelines and state policy decisions. For the most accurate and up-to-date information, contacting the Missouri Department of Social Services or visiting their official website is recommended.

Applying for MO HealthNet can be done through several methods, allowing for accessibility and convenience for all applicants. Here's a step-by-step guide on how to apply:

Online Application

1. Visit the Official MO HealthNet Application Portal: The easiest and fastest way to apply is online through the Missouri Department of Social Services website. Access the application portal by visiting mydss.mo.gov.
2. Create or Log In to Your Account: If you're a new user, you must create an account. If you already have one, log in.
3. Complete the Application: Fill out the application form with all required information, including personal details, income, household size, and other necessary documentation.

In Person

Local Family Support Division (FSD) Office: You can apply in person at any FSD office. To find the nearest office, visit mydss.mo.gov/office-locator or call the FSD Information Center at 1-855-373-4636 for locations and hours.

By Mail or Fax

1. Download and Print the Application: Forms can be downloaded from mydss.mo.gov. Choose the application that best fits your situation.
2. Mail: Send it to the Family Support Division, P.O. Box 2320, Jefferson City, MO 65102.
3. Fax: Fax it to 573-526-9400.

Phone Application

Call the FSD Information Center at 1-855-373-4636 to apply over the phone. The center is open Monday through Friday, from 7:30 a.m. to 6:00 p.m., where trained staff can assist you through the application process.

Required Documentation:

Regardless of the method chosen, you'll need to provide certain documents to support your application, such as:

• Proof of income (e.g., pay stubs, tax returns)
• Identification (e.g., driver's license, birth certificate)
• Proof of residency (e.g., utility bill, lease agreement)
• Other relevant documents (e.g., proof of pregnancy, disability documentation).

For assistance during the application process or more information, contact the Family Support Division Information Center at 1-855-373-4636. The FSD's website and staff can provide guidance, answer questions, and help navigate the application process effectively.

Renewing Medicaid coverage in Missouri is critical to ensure that your healthcare benefits continue without interruption. Medicaid coverage needs to be renewed annually, and the Missouri Department of Social Services (DSS) will notify recipients about their renewal date and the steps they need to follow. Here's what you need to know about the renewal process:

Notification

The Family Support Division (FSD) will send you a renewal notice before your renewal date. This notice will arrive in the Mail and include instructions on renewing your coverage and the deadline for doing so.

How to Renew

You can renew your MO HealthNet coverage in several ways, similar to the initial application process:

• ‍Online: The fastest and most convenient way to renew your Medicaid coverage is through the Missouri Department of Social Services website. Visit mydss.mo.gov and log in to your account to access the renewal application.‍
• By Mail: You will receive a renewal form and your renewal notice in the Mail. Complete this form and return it to the address provided. If you've lost the form, you can download a new one from the DSS website.‍
• By Phone: Call the Family Support Division Information Center at 1-855-373-4636. The staff can assist you with the renewal process over the phone.‍
• In Person: Visit your local Family Support Division office to renew your coverage. Find your nearest office by visiting mydss.mo.gov/office-locator or calling the Information Center for directions.

After Renewal

• Review Process: The FSD will review your renewal application to determine whether you qualify for Medicaid benefits.
• Notification: You will receive a notice informing you whether your Medicaid coverage has been renewed or if additional information is needed.
• Appeal Rights: If your Renewal is denied and you disagree with the decision, you have the right to appeal.

Important Tips

• Update Your Contact Information: Ensure your contact information is up-to-date with the FSD to receive all notices and communications.
• Respond Promptly: To avoid a lapse in coverage, respond to any requests for information and complete your renewal by the deadline specified in your renewal notice.

For assistance with the renewal process or questions, contact the Family Support Division Information Center at 1-855-373-4636. The FSD staff can provide support, clarify the renewal steps, and help ensure that your coverage continues seamlessly.