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Medicaid Facts for Missouri Residents

May 20, 2020

This guide was written for individuals who are hoping to qualify for Medicaid in Missouri. Medicaid is funded at both the state and federal levels and this program guarantees the provision of certain health services to individuals who meet specified eligibility requirements. The article below is the best Medicaid guide for Missouri residents who wish to determine their eligibility for the program.

 

Each state has its own requirements regarding who qualifies for Medicaid. However, the federal Centers for Medicare and Medicaid Services (CMS) manages the baseline standards for funding, service delivery, quality, and eligibility requirements across all states in the US. Thus, the Missouri Medicaid program is required to follow the standards set by CMS, but it also has established some of its own rules and regulations based on the state’s needs.

 

In Missouri, the Medicaid program is called MO HealthNet and it provides services to the elderly, disabled and blind individuals, children, pregnant women, and low-income individuals throughout the state. To learn more about eligibility, what services are covered by the MO HealthNet program, the application and approval process for new applicants, and more, continue reading.

 

This guide is broken into three parts covering:

 

1) Facts about Medicaid

 

2) Eligibility requirements for Medicaid

 

3) The application process and contact information for the program in Missouri.

Section 1: Facts about Medicaid in Missouri.

Medicaid is a health insurance program that is both state and federally funded. The state of Missouri is responsible for administering the program which is called MO HealthNet. The MO HealthNet Division takes care of the provision of payments while the DSS Family Support DIvision (FSD) determines which individuals and families are eligible for the program.

 

Most of the adults who are covered by Medicaid in Missouri are women, but children are the largest demographic group currently served by the program. Approximately 78,100 elderly individuals (people over 65 years of age) are covered by Medicaid in Missouri. There are 144 FSD Resource Centers located throughout the state in a variety of different locations.

 

According to federal guidelines set by the Centers for Medicaid and Medicaid Services (CMS), the state of Missouri is required to cover a certain minimum set of services through Medicaid including:

 

●       Outpatient services

●       Inpatient services

●       Nursing facility services

●       Skilled home health services

●       Coverage of durable medical equipment

●       Home care services

●       Physician services

●       Psychiatric services

●       Family planning services and supplies

●       Lab and x-ray services

●       Dental services (including medical and surgical services)

●       Nurse-midwife services

●       Certified family nurse practitioner services

●       Certified pediatric nurse practitioner services

●       Screening and treatment of children under 21 years of age (according to the EPSDT/HCY program)

●       Non-emergency medical transportation

 

The Missouri Medicaid program will occasionally offer extra coverage of services that are not required to be covered. In certain cases, Missouri Medicaid will provide individuals with coverage of the following “optional” services:

 

●       Pharmacy services

●       Rehabilitation and specialty services

●       Mental health services (this may be required for some individuals)

●       Psychiatric services and care

●       In-home care

●       Dental visits

What are the eligibility requirements for Medicaid in Missouri?

 

The MO HealthNet program covers individuals who meet certain income and resource criteria including:

 

●       Low-income families (children, parents, guardians, and caregivers)

●       The elderly

●       Blind/visually impaired individuals

●       Disabled individuals

●       Pregnant women (during pregnancy and postpartum)

●       Newborns and infants

●       Uninsured women under the age of 65

 

The income criteria for eligibility is determined by poverty guidelines set forth by the federal government. Resource criteria typically apply only to the elderly, disabled, and blind individuals. For these applicants, resources such as savings and countable assets can impact eligibility for the program.

 

Blind and disabled individuals can qualify for Medicaid due to a “physical or mental impairment, disease, or loss” that prevents them from working at a job within their skill level for 1 year or longer. Anyone who qualifies for assistance through the federal Supplemental Security Income (SSI) program is automatically considered eligible for the MO HealthNet program on the basis of disability.

What is the income limit for Missouri Medicaid?

 

Individuals who qualify for the federal Supplemental Security Income program who are disabled according to the SSI guidelines are eligible for Missouri Medicaid as long as their income doesn’t exceed certain levels. For disabled individuals, income should not exceed 85% of the Federal Poverty Level (FPL). For blind individuals, income should not exceed 100% of FPL. Some disabled individuals may also qualify to receive MO HealthNet financial assistance to pay for Medicare premiums, deductibles, and copayments.

 

The elderly can sometimes spend down their incomes or medical expenses in order to meet the Medicaid income requirements in Missouri. “Spending down” is a term that refers to the amount of medical expenses that a person must pay monthly in order to become eligible for Medicaid coverage. An individual or couple may need to spend down their income so that their net income is equal to or lower than the income eligibility requirement for the Missouri Medicaid program.

 

“Spending down” to meet income eligibility requirements may include either of the following:

 

●       Monthly submission of medical expenses to a caseworker

●       Monthly payments of the spend down amount to the MO HealthNet Division (like an insurance premium payment)

 

In order to qualify for Medicaid, individuals must have a very low level of “countable assets”. Eligible individuals should have $2000 or less of countable assets. Assets will be reviewed from the date of the application to 5 years prior to make sure that no asset transfers occurred. Assets that exceeded the program limit will need to be spent down before Medicaid coverage can commence. For more information about assets and eligibility for Medicaid, see Section 2.

 

MO HealthNet may also provide assistance to some seniors to pay their Medicare premiums, deductibles, and copayments.

How long does it take to get approved for Medicaid in Missouri?

 

Under normal conditions, Medicaid applications are processed within 30 to 45 days in Missouri, but sometimes it can take up to 90 days depending on how many other people are attempting to enroll in the program at the same time. You can speed up the processing time of your application by making sure that it is complete and all of the necessary information is correct.

 

Elderly applicants for Medicaid may experience a processing delay in Missouri as their assets are being assessed. Assets for five years prior to the application date are reviewed to determine eligibility and this review process can create delays in the normal amount of time it takes to get approved (or denied) for Medicaid coverage in Missouri.

 

Section 2: Who is eligible to apply for Medicaid in Missouri?

 

Eligibility for the MO HealthNet program is based on several factors including income and resource criteria. Disabled, blind, and elderly individuals who meet the income and resource requirements may qualify as well as pregnant women and children. Indeed, children make up the majority of Medicaid recipients in the state of Missouri at this time.

 

Low-income women who are pregnant or who have recently given birth may qualify for Medicaid. Parents, guardians, and caregivers in low-income families may also be eligible. The goal of the program is to make sure that low-income individuals are able to find good health, treat illness, avoid premature death, and correct, rehabilitate, or limit a disability.

 

To qualify for the MO HealthNet program, applicants must be U.S. citizens, permanent residents, legal, aliens or nationals and a resident of Missouri who is in need of health care and insurance assistance. Your financial situation must be considered “low-income” or “very low-income” according to certain federal and state guidelines. And you must also be disabled (or have a dependent family member who is disabled), blind, elderly (over age 65), pregnant, or be a parent or relative caregiver of dependent children who are under the age of 19 years. 

 

In Missouri, there are several different long-term care programs for seniors and each have different eligibility requirements and benefits. The criteria for eligibility depend somewhat on marital status, but needless to say, there are several different pathways that seniors can take to become eligible for the program.

Income Criteria

 

Any income that a Medicaid recipient receives is counted. Income is money that comes in through any source including:

 

●       Employment wages

●       Social security payments

●       Pension payments

●       Alimony payments

●       IRA withdrawals

●       Stock dividends

 

Federal guidelines are used to determine the income requirements for qualifying Medicaid applicants. These guidelines are based on the Federal Poverty Level, but they vary depending on the individual reasons why the person is applying for Medicaid. For example, disabled individuals should not have an income that exceeds 85% of the Federal Poverty Level while those who are blind are not allowed to exceed 100% of the Federal Poverty Level.

 

To qualify for Medicaid in Missouri, your annual household income must be less than or equal to the amounts below:

 

●      Household size - 1 person: $16,612

●       Household size - 2 people: $22,491

●       Household size - 3 people: $28,369

●       Household size 4 people: $34,248

●       Household size 5 people: $40127

●       Household size 6 people: $46,005

●       Household size 7 people: $51, 884

●       Household size 8 people: $57,762

●       For households of more than 8 people, add $5,878 per person.

 

Blind and disabled individuals who cannot work at their skill level for one year or longer can automatically qualify for Medicaid assistance if they have already qualified for the federal Supplemental Security Income program through the federal government.

Assets Criteria

 

Individuals who are eligible for Medicaid must have $2000 or less in countable assets. To determine eligibility, assets are reviewed for the 5 years prior to the date of application to make sure that there were no asset transfers that would negatively affect eligibility. In some cases, assets over the $2000 limit can be spent down to achieve the necessary resource criteria. 

 

According to Medicaid eligibility requirements, countable assets including the following:

 

●       Investments

●       Stocks

●       Bonds

●       Credit union

●       Savings

●       Checking accounts

●       Investment Real Estate (not including housing in which the applicant currently resides)

●       Cash

 

Assets that are exempt (or not countable) according to eligibility requirements include the following:

 

●       Household furnishings

●       An automobile

●       Irrevocable burial trusts

●       Personal belongings

●       A primary home (as long at the Medicaid applicant or their spouse currently lives in the home and the home is valued at less than $595,000).

 

Married couples can have the non-applicant spouse retain half of the couple’s joint assets up to certain limits. If the couple’s assets are less than $25,728, the non-applicant spouse can claim 100% of the assets (referred to as the Community Spouse Resource Allowance). This allowance is not applicable to regular Medicaid applicants.

How much money can I have and still qualify for Medicaid?

There are several different factors that pertain to Medicaid eligibility in Missouri. Eligibility ultimately depends on the applicant’s specific health situation and marital status. The amount of money that you can have varies depending on these various factors. Below are 3 different types of Medicaid in Missouri and the maximum amount that applicants can make to become eligible for the program:

 

●       Regular Medicaid: 

○       Single income limit: $904 per month / $4000 assets

○       Married (both spouses applying)  income limit: $1222 per month / $8000 assets

○       Married (one spouse applying) income limit: $1222 per month / $4000 assets

 

●       Medicaid Waivers and Home/Community-Based Services:

○       Single income limit: $1370 per month / $4000 assets

○       Married (both spouses applying): $2740 per month / $8000 assets

○       Married (one spouse applying): $1370 per month  / $4000 assets

 

●       Institutional/Nursing Home Medicaid:

○       Single income limit: All available income must go toward care. / $4000 assets

○       Married (both spouses applying): All available income must go toward care. / $8000 assets

○       Married (one spouse applying): All available income must go toward care. / $4000 assets

 

When only one spouse in a married couple applies for nursing home reimbursements from Medicaid or an HCBS Medicaid waiver, only the applicant’s income is counted to determine eligibility.  When both spouses apply, the income and assets of both individuals are calculated together to determine their eligibility.

Section 3: How to apply for Medicaid in Missouri.

How to sign up for Medicaid?

Missouri residents can sign up for Medicaid either online, by phone, through the mail, or in person at a designated Medicaid office. The online application is one of the more popular options for applicants to use, but all three of these application processes are available. Applicants should make sure that they qualify and have the required documents available before starting their Medicaid application.

 

No matter how you apply for Medicaid, you will need to submit the following documents and information along with your Medicaid application form:


●       Proof of United States citizenship

●       Proof of Missouri residency

●       Income statements (can include tax forms and pay stubs)

●       Social security number

●       Current living address

●       Phone number

●       The number of people in your household

 

For people who are applying for Medicaid not only for themselves, but also on behalf of their family, they will need to submit the above information for every family member that they are applying for. A separate Medicaid application may need to be completed for each family member as well. If you have questions about applying for yourself and your family members, contact a Medicaid office close to you and ask to speak with an Authorized Representative.

 

To apply for Medicaid online applicants will use Missouri’s special healthcare website (MO HealthNet). You will submit all your required documents and information through the website’s online application system. It’s very important to be as thorough and honest as possible as you go through the sign-up process because the more information you can include to validate your Medicaid eligibility, the more likely it is that you will be accepted to the program.

 

When applying online through the MO HealthNet website, there are different application processes available for people in different situations. This is because different people may have somewhat different documents that they need to submit; for example, someone applying for Medicaid on behalf of their family would need to submit different documents than someone who is blind or disabled and applying for Medicaid. Make sure to select the correct option for your situation so that you are able to submit all the required information and documents easily.

 

After applying online through MO HealthNet, you can generally expect to hear back within a few weeks to a month as to whether or not you have been accepted to the Medicaid program. Keep in mind that the more thorough you are in your application, the more likely it is that you’ll be accepted, and it’s also more likely that the process will go faster. Applying online through MO HealthNet is often the fastest method to use to apply for and be accepted to the Medicaid program.

 

The second option is to apply for Medicaid over the phone. This is the most popular option for people who want extra help when going through their application, or for individuals in special circumstances. Operators are available who speak other languages, like Spanish, for example, if you would prefer to receive help in another language. Contact the MO HealthNet platform directly via phone or locate the contact information for the nearest Family Support Division.

 

Some Medicaid Family Support Division offices in Missouri are now accepting applications via fax as well. If you would like to submit your Medicaid application by fax, start the application process over the phone and then follow the operator’s instructions to submit your application and the required supporting documents via fax.

 

Many individuals in Missouri choose to apply for Medicaid through mail. If you’d prefer to be able to send in your physical documents and application form for review but you’re not able to visit an in-person Medicaid application center, then this is one of the best options. Visit the MO HealthNet website to download and print the application form. It is also possible to call and request that the required Medicaid application forms be sent to you via mail.

 

When filling out an application form sent to you in the mail, just like with any application, make sure to read the instructions very carefully to ensure that you fill the form out correctly. It’s also very important to sign and date the document before sending it. Failure to follow the instructions on a Medicaid application form can result in rejection or severely delayed processing times.

 

The final option is to apply in-person at a designated Medicaid application center. Applying in person is best for people who have questions or who need specific assistance during the application process due to unusual circumstances or multiple applications (such as in the case of families). Many application centers in Missouri have on-staff application assistants who are available to help you through the process and receive finished applications.

 

The in-person offices where you can apply for Medicaid in Missouri are called Family Support Divisions. Visit the office closest to your residence so that you receive the best advice and fastest processing times. You can either print out the Medicaid application form online and then drop it off at the nearest Family Support Division, or you can visit a Medicaid application office and receive an application to fill out there in person.

 

Application forms at Missouri Family Support Division offices are currently available in English, as well as in Spanish, Vietnamese, and Bosnian. If you speak another language other than these, request help from a representative right away so that you can get the help that you need. At Medicaid offices in Missouri, it’s important to seek out an Authorized Representative for help during the application process. These individuals know the details of the application process and are qualified to help anyone with any situation.

 

When applying for Medicaid, it’s not uncommon for  individuals to submit more documents after their application has been reviewed. Often, after a Medicaid application has been reviewed by the state, more supporting documents are necessary for validation and verification of certain details. If more details are needed for your application to be processed, you will be contacted through mail or by phone about the additional necessary documents that you need to submit. If you submitted online, you may also be contacted via email by an MO HealthNet representative.

 

Missouri Medicaid applications can sometimes take a bit of time to process and be accepted. If you want to check on the status of your application, you can either contact MO HealthNet online or over the phone at 1-888-275-5908. Most often, it takes approximately one month for Medicaid applications to be reviewed and accepted, though some applications may take slightly less or slightly more time depending on the individual applicant’s situation.