Missouri Medicaid (MO HealthNet) Guide

Missouri’s Medicaid program is also called MO HealthNet.* The program provides health insurance to eligible Missourians. Since MO HealthNet was created for low-income individuals and families, most people with MO Medicaid will not pay much at all. Most people will only be responsible for co-pays ranging from as little as $0.50 to $10. Use our chart below to find out if you may be eligible!

*Be careful to not confuse MO HealthNet with Health Net, a Centene company.

This MO Medicaid Guide Includes:

• Missouri Medicaid Eligibility Chart
• What Does MO Medicaid Cover?
• Completing the Missouri Medicaid Application
• Dual Eligibility and Missouri Medicare

Missouri Medicaid Eligibility Chart

You may be eligible for MO Medicaid if you are living in poverty or if you are permanently and totally disabled. To be eligible, you must also live in Missouri and be a U.S. citizen or eligible non-citizen and you must not reside in a public institution. To qualify based on your poverty status, you must meet the following income guidelines. If you do not meet the income guidelines below but your medical expenses leave you living at the numbers below, you may still qualify.

Additional qualifiers:

• “Permanently and totally disabled” refers to the inability to remain employed for one year or more due to a physical or mental disability.
• Blind and visually disabled persons who have a sighted spouse who can provide support may be denied coverage.
• Must have vision less than 5/200 to be considered blind
• Blind qualifiers must not publicly solicit alms
• Children in families at over 150% of the FPL may need to pay a premium for MO HealthNet.

What does MO Medicaid Cover?

Subject to limitations, the program covers:

• Inpatient and outpatient hospital services
• Ambulance travel and ambulance treatments
• Hospice
• Labs and x-rays when prescribed
• Nursing home services and adult day care
• M.D. or D.O. doctor and nurse practitioner services
• Prescriptions and immunizations
• Hearing aids and audiology
• Podiatry
• Family planning and midwife services
• Rehabilitation and therapy services
• Transplants
• Certain home-based services
• Orthodontics
• EPSDT (early and periodic screening, diagnosis, and treatment) for those under 21

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Dental and Vision

Medicaid dental coverage for kids is standard across all 50 states, but adult coverage is different in every state. Kids have coverage for pain relief, infection treatment, tooth restoration, and dental maintenance. These services refer to cleanings and checkups, fluoride treatments, sealants, fillings and crowns, root canals, and necessary emergency services. Missouri adults with Medicaid have coverage for exams, x-rays, cleanings, fillings, and extractions. Click here for a list of Missouri dental providers who work with Medicaid and low-income or uninsured patients.

Similarly to dental coverage, Medicaid vision coverage is different for adults and children. Missouri kids have coverage for one eye exam every year, glasses frames every two years, and lenses every two years when medically necessary. Replacement of broken or lost frames may be covered if deemed medically necessary and if pre-approved by Medicaid. Your doctor can help you with the pre-approval process. Adults with MO HealthNet have coverage for one eye exam every two years (yearly for the blind, pregnant, and nursing home residents), and frames and lenses every two years when medically necessary. Copays for vision services range from $0.50 to $3.

Prescription Drugs

The Pharmacy Program by MO HealthNet is a comprehensive prescription drug program with very little copays. Kids almost never have to pay copays through this program, and most adults will not pay more than one or two dollars for prescriptions. Some prescriptions will require prior authorization before a pharmacist can prescribe it to a Medicaid beneficiary. Most prescriptions on the preferred drug list will not require prior authorization.

Transportation (NEMT)

NEMT, or Non-Emergency Medical Transportation, is a benefit allowing eligible Mo HealthNet beneficiaries to receive transportation to and from doctors appointments for just $2 per trip. NEMT is for the beneficiary and, if necessary, a child or guardian who needs to come along. Generally, this benefit is intended for your healthcare providers who accept Medicaid coverage. If you need NEMT for an appointment that is far away or that is not usually covered, you may need to get a note from your doctor stating why you need the NEMT. In most cases, this program does not provide transportation to pharmacies. We recommend mail-ordering your prescriptions whenever possible.

To use the NEMT benefit, call 1-866-269-5927 at least five days before your appointment (M-F, 8 AM to 5 PM). If you have a medical emergency and need to get to a hospital, please call 911. When you call to set up a NEMT ride, you will need your MO HealthNet ID number. You will also need the name, address, and phone number of your drop off location and information about your appointment. You will also need to prove that you require transportation. NEMT services are not available for those who are capable of driving themselves. Some people may be eligible for gas reimbursements instead. If you are denied NEMT, you may be able to find free or low-cost rides from public transportation or from one of your local community organizations.

Smoking Cessation

The state of Missouri recognizes that quitting your smoking habit is often the first step towards a healthier lifestyle. MO HealthNet provides free nicotine gum or patches (while supplies last). If you are not currently insured but need a jump start to quit smoking, you may still be eligible for a small supply. To register, click here or call the Missouri Tobacco Quitline (1-800-QUIT-NOW).

Completing the Missouri Medicaid Application

You can apply for Missouri Medicaid by downloading this form and mailing it to the address on the first page. You can also apply online by clicking here.

When completing the Missouri Medicaid application, you may need the following:

• Proof of income
• Guardian or power of attorney paperwork and contact information.
• Proof of marital status, if applicable
• Birth certificate
• Proof of veterans benefits, if applicable
• Documentation of any stocks, bonds, 401ks, IRAs, etc. that you have
• Proof of any other forms of insurance you have
• Documentation for any property you own

Dual Eligibility and Missouri Medicare

If you are eligible for Missouri Medicaid and are also over the age of 65 or living with a qualifying illness, you may be eligible for Medicare as well. In this case, you can enroll in a DSNP, or dual-eligible special needs plan. DSNPs are a form of Medicare Advantage for people who benefit from both programs. Most people who have a DSNP will have all or most of their healthcare covered.

For help enrolling in a DSNP in your area, get in touch with a Medicare Plan Finder agent. Send us a message or give us a call at 844-431-1832 to get started.

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