Accessing MO HealthNet Coverage
After months of hard-fought battles, certain Missourians can finally begin to access health care coverage guaranteed to them under the state constitution.
In August 2020, Missouri voters approved a constitutional amendment to expand Medicaid coverage to cover adults making up to 138 percent of the federal poverty level. Even though this constitutional amendment was approved, the effort to implement Medicaid expansion has faced several challenges, including a number of court hearings. Ultimately, supporters of expansion won out, and in accordance with the Cole County Circuit Court’s Aug. 10 order, newly eligible individuals may now apply for health care coverage through Missouri Medicaid (known as MO HealthNet) under Article IV Section 36(c) of the Missouri Constitution.
To help Missourians navigate these new services they may be eligible for, I have included a handy FAQ guide on applying for MO HealthNet coverage below.
Who is eligible for MO HealthNet?
Non-disabled adults between the ages of 19 and 64 may now be eligible for coverage through MO HealthNet if they:
- Live in Missouri and are a United States citizen (or qualified non-citizen);
- Make less than the annual income limit for their household size; and
- Are not eligible for or receiving Medicare Part A or B, MO HealthNet for families, MO HealthNet for pregnant women or Non-Spend Down MO HealthNet for the aged blind and disabled.
NOTE: If you have custody of children, they must also have health care coverage for you to be eligible for coverage.
What services are covered?
The MO HealthNet benefits chart offers a list of covered services. It is important to note that some services may be limited based on your age or eligibility, and other services may be available depending on your needs. You should always check with your provider to see if the service you need is covered.
How do I apply?
There are many ways you can apply for MO HealthNet benefits, depending on what works best for you. Visit the MO HealthNet application webpage to learn more about how you can apply and the steps you need to take to submit your application.
What happens after I apply?
Once your application is processed, you will get a letter that lets you know if you are eligible for health care coverage or not. If you are approved, you will receive a MO HealthNet Identification Card and information explaining the type of coverage you have. You will need to follow the instructions in the letter for your coverage to begin.
NOTE: If you apply before Nov. 1, 2021, DSS will automatically explore your coverage start date back to July 1, 2021. If you apply after Nov. 1, 2021, and you would like the department to explore your coverage for prior months, you will need to indicate you have had medical services in the last three months (Step #4 on the application) when you apply.
How long will it take the Family Support Division to process adult expansion coverage applications?
It may take up to 45 days to process an application. The Family Support Division began processing applications in the Medicaid Eligibility Determination and Enrollment System on Oct. 1, 2021.
I already have MO HealthNet. Will my coverage change?
The Family Support Division will reach out to you directly if there is a change in your coverage for any reason. If your contact information (phone number, address, etc.) has changed, please be sure to report it as soon as possible so they can contact you as needed. You can report a change online anytime here.
I already applied, but my job has changed since I submitted my application. What should I do?
You must let the department know about any changes, including changes in employment or income, through DSS’s website within 10 days of the change.
Will the question about using tobacco affect my eligibility?
No, this will not affect your eligibility for any MO HealthNet programs (including adult expansion coverage). This question is a federal reporting requirement.
If I paid a bill to a Medicaid provider in July, and I am later found to be eligible for adult expansion coverage, how will reimbursements work?
Payment reimbursements are between the provider and patient. Patients should give providers their approval notice and providers should check for coverage dates.
Will there be an annual review period for individuals with adult expansion coverage?
Yes, individuals will be required to complete an annual review each year they get MO HealthNet to make sure they are still eligible.
Who should I contact with questions?
If you have questions about applying for MO HealthNet, please visit the MO HealthNet application webpage or contact the department at 855-FSD-INFO (855-373-4636). If you already have MO HealthNet and you have questions about your health plan, covered services or your plan’s health care providers, please reach out to your Managed Care Health Plan.
If you have further questions about MO HealthNet or other services provided through the state of Missouri, please contact my office at (573) 751-6607. For information about my committee assignments or sponsored legislation, please visit my official Missouri Senate website at senate.mo.gov/Razer.