Medicaid / MO HealthNet

MO HealthNet, otherwise known as Medicaid, is a government health insurance program that helps people with low income get health care services at a lower cost. There are several different MO HealthNet programs in Missouri, each serving a different group of people.

What does Missouri MO HealthNet cover?

Missouri MO HealthNet pays for routine and acute health care services. This includes:

• Visits to health care providers (including physicians and nurse practitioners)
• Inpatient and outpatient hospital services
• Early and periodic screening, diagnostic, and treatment services
• Preventive care (e.g., vaccinations)
• Lab tests and X-rays
• Dialysis services
• Mental health services
• Substance use treatment
• Rural health clinic services
• Medical transportation
• Long-term care (e.g., nursing facility care, home health services)

Most states also cover optional services such as:

• Physical, respiratory, and occupational therapy
• Home- and community-based care
• Case management
• Prescription drugs
• Dental and vision care

Since the program serves those with limited income and resources, people with Missouri MO HealthNet (Medicaid) pay few to no out-of-pocket costs. To get coverage once you are enrolled, you must go to health care providers that take part in the Medicaid program.

MO HealthNet is administered by the Missouri Department of Social Services (DSS).

How do I know if I qualify for Missouri MO HealthNet?

In general, to be eligible, you must:

• Be a Missouri resident
• Be a U.S. citizen or a qualified non-citizen
• Meet the income and (if applicable) resource limits for your coverage group

Also, if you receive or qualify for Supplemental Security Income (SSI), you may be automatically enrolled in MO HealthNet.

If you need help with your health care coverage and costs, you should apply for MO HealthNet even if you think you are over the income limit. This is because:

• Not all types of income are counted toward the income limit.
• You may qualify for a different form of health care assistance.
• If you are over the income limit, but you have very high medical costs, you may be able to qualify for MO HealthNet through the Spend-Down Program.

What are the different MO HealthNet programs in Missouri?

You may be able to get health coverage if you fall into one of the following categories:

MO HealthNet for the Aged, Blind or Disabled (MHABD)

MHABD covers people who are age 65+, blind, or living with a disability who also have limited income and resources.

Medicaid - Aged and Disabled Waiver

The Aged and Disabled Waiver helps people age 63 and older who need care at home. It is for those who might need to live in a nursing home without help. Services can include help with cleaning, short breaks for caregivers, meals delivered to the home, and adult day care.

Missouri Care Options (MCO)

This Medicaid program helps older adults and adults with disabilities in Missouri get the care they need to stay at home or in their community, instead of moving into a nursing home.

Supplemental Nursing Care Program

This program provides a monthly cash benefit if you are a qualifying resident of a licensed residential care facility (RCF) or assisted living facility (ALF). Nursing home residents may also qualify but usually receive nursing home coverage instead. The payment includes a personal needs allowance. The amount of cash you can receive will depend on the type of place you live.

You can get help from this program if you fit one of the following categories:

• 65 years of age or older
• Under 65 with a permanent disability
• 18 years of age or older and blind

You must also have limited income and resources.

HealthNet Ticket to Work Health Assurance

This program is for people who are paid workers and have a disability. If you qualify, it allows you to work, or to increase how much you earn, without losing your Medicaid coverage. You may have to pay a monthly premium.

Nursing Home Medicaid

Nursing Home Medicaid covers health care and support services in a nursing home or other medical facility. If you qualify, Medicaid may cover room and board, nursing care, rehabilitation services, and other services. You can get this coverage if you have limited income and resources. You must also have a medical condition that requires the skills of a licensed nurse on a regular basis.

Spend-Down Program (Medically Needy)

The Spend-Down Program, also called the Medically Needy Program, lets you get MO HealthNet benefits even if your income is higher than program guidelines. It works by letting you spend down your income so that you meet Medicaid’s income limits. The spend-down amount is the amount of income that is over the MO HealthNet limit. This amount is different for each person.

To get MO HealthNet benefits, you must submit current paid or unpaid medical bills equal to or greater than your monthly spend-down amount. Once your medical bills reach this amount, you will get Medicaid coverage for the rest of the calendar month. While using MO HealthNet to pay for your medical expenses, you should use a health care provider who takes part in Medicaid.

Some examples of medical expenses you can use to spend down your income include:

• Unpaid medical bills (that have not been used to spend down your income before)
• Health insurance premiums
• Medical bills you paid within the last three months
• Medical bills that will not be paid by health insurance (or any other source)
• Co-pays for medical bills
• Medical services prescribed by your doctor
• Transportation by ambulance, bus, or taxi to get health care services

How do Medicare and MO HealthNet work together?

MO HealthNet (Medicaid) pays for some services not covered by Medicare. If you get Medicare, you may also be able to get help from MO HealthNet. Millions of Americans have both Medicare and Medicaid coverage. This is called being "dual eligible."

If you have Medicare and qualify for full MO HealthNet coverage, the state will pay your Medicare Part B (Medical Insurance) monthly premiums. Depending on the level of Medicaid you qualify for, the state might also pay for:

• Your share of Medicare costs, like deductibles, coinsurance, and copayments
• Part A (Hospital Insurance) premiums, if you have to pay a premium for that coverage

If you have both Medicare and Medicaid in Missouri, you should show both cards to your health care provider each time you receive services.

In addition, if you are dual-eligible for Medicare and MO HealthNet:

• You will automatically be signed up for the Low-Income Subsidy (LIS)/Extra Help program through Medicare Part D (prescription drug coverage). This program helps people with low income pay for their medicines.
• You can get your coverage through a Medicare Advantage Special Needs Plan (SNP) instead of having original Medicare with separate Medicaid coverage. This plan can help you manage the health care services you need. SNPs may also offer more benefits than what you already get from original Medicare. In some cases, you may have no monthly premiums and/or you may pay lower co-payments. All SNP plans are different, so check with the plans to see what they cover and if you can enroll.

Note: SNPs are not available in every community. To find out if there is an SNP in your area, visit the Medicare website or call 1-800-633-4227 or 1-877-486-2048 (TTY).

How do I prepare to apply for Missouri MO HealthNet?

When you apply for MO HealthNet, you’ll be asked for important information to help determine if you qualify for benefits. Before you start, gather some basic information to make your application process easier: 

• A document that shows your age, such as your birth certificate or driver’s license
• Your Social Security card
• Pay stubs for anyone in your household who has earned income
• Documentation that shows any other form of income, such as letters from Veterans Affairs (VA) or the Social Security Administration (SSA)
• Information about your financial assets, such as bank account or investment account statements

How do I apply for MO HealthNet?

There are a few different ways you can apply for MO HealthNet in Missouri. Read below to learn more about which option might be right for you.

The quickest and easiest way to apply for MO HealthNet and other public assistance benefits is online through the MyDSS website. All your personal information is kept 100% confidential and protected by special security technology.

Apply Online

To apply in person or by mail, you will need a paper application. Click below to download and print the Missouri Application for Health Coverage:

• Application for Health Coverage (English)

Once you fill out the application, you can drop it off in person at a DSS office near you or mail it to:

Family Support Division
P.O. Box 2700
Jefferson City, MO 65102

To apply by phone, call the Missouri MO HealthNet Hotline at 1-855-373-9994.

How can I get help with my application?

• Call the MO HealthNet Hotline at 1-855-373-9994.
• Visit a Benefits Enrollment Center (BEC), if there’s one near you. See if there’s one in your area.
• NCOA also has a HelpLine you can call to get free support. To get started today, call 1-800-794-6559.