Medicaid, referred to as MO HealthNet in Missouri, provides health care to families, pregnant women, children, older adults, low-income individuals and people with disabilities. The program plays a critical role in responding to the COVID-19 pandemic by ensuring Missourians have access to testing and treatment as well as safe access to other health care services.
What’s New with Medicaid
Here are important highlights and changes to Medicaid during the COVID-19 pandemic:
People who are enrolled in Medicaid will not have any co-payments for COVID-19 testing.
Uninsured Missourians ages 19-64 who test positive for COVID-19 may be eligible for Medicaid coverage. Their individual monthly income cannot exceed $904 and must be less than $1,222 for married couples. Resource limits are $4,000 for individuals and $8,000 for couples.
Missouri will not terminate anyone’s Medicaid coverage during the COVID-19 emergency. People who have coverage as of March 18, 2020 will remain enrolled unless they move to another state or provide a written request to be removed.
Medicaid is encouraging the use of telehealth during the pandemic by implementing the following changes.
- Physicians and patients do not need to have an established relationship before using telehealth.
- Licensed physicians in another state can provide telehealth services to Missouri Medicaid participants.
Medicaid Expansion in MO
On August 4th, 2020 Missourians across the state voted to expand Medicaid eligibility criteria, providing access to vital healthcare to over 275,000 additional Missourians. Medicaid, also know as MO HealthNet in Missouri, provides health insurance to low-income children and parents, disabled community members, pregnant people, and seniors.
Under expansion, the follow individuals can now qualify for lifesaving health coverage:
- An individual who earns less than $18,000 per year
- A family of four who earns less than $36,000 per year
Have questions about whether you or someone you know may qualify under expansion?
Medicaid has income and resource eligibility requirements based on who is applying for the program. Income restrictions based on the federal poverty level (FPL) are provided below.
- Children (up to age 19) = Income 300% FPL
- Parents = Income ~22% FPL
- Pregnant Women = Income 300% FPL
- Individuals with a Disability = Income 85% FPL
- Older Adults (age 65+) = Income 85% FPL
- Blind Individuals = Income 100% FPL
More information can be found on the myDSS website.
Medicaid is required to cover a number of health care services, including:
- Inpatient & outpatient hospital care
- Physician services
- Family planning services
- Home health care
- Nursing facility care
- Labs and X-rays
- Non-emergency medical transportation
- Early and periodic screening, diagnostic, and treatment services (EPSDT)
Missouri also provides additional benefits, including: pharmacy, rehabilitation, mental health care, in-home care, and dental care. Benefits can vary based on the participants’ eligibility and the type of Medicaid they are enrolled in.
Department of Social Services
Family Support Division
Medicaid Questions & Answers
Applications and verification documents (i.e. copies of paystubs, statements, identification, etc.) can also be emailed or faxed to the department. Do not send questions to the email or fax number as the department is unable to respond to these messages.
- Email: FSD.Documents@dss.mo.gov
- Fax: 573-526-9400
You can call 1-855-373-4636 on Monday – Friday 6:00 AM – 6:30 PM. You can text 855-684-9294 as well.
To check the status of an application, you can call the automated information line at 1-800-392-1261 anytime. You will need your Social Security Number and date of birth when calling.
Medicaid will cover Missourians ages 19 to 64 who test positive for COVID-19 and meet the income guidelines. Income can’t exceed 85% FPL and assets can’t exceed $4,000 for individuals and $8,000 for couples.
Additionally, Medicaid will not terminate any current participant’s coverage during the public health emergency unless the individual requests to be removed or moves to another state.
People enrolled in Medicaid can use telehealth (e.g. teleconferencing, sending medical information or media electronically, etc.) at home during the pandemic. Medicaid covers telehealth services from a licensed health care provider as long as the service is within the provider’s scope of practice and follows the same standard of care as if the service were administered in person.
Medicaid is also promoting the use of telehealth during the COVID-19 pandemic with these steps.
- Providers who are in quarantine may administer telehealth services while at home.
- Physicians and patients do not need to have an established relationship prior to using telehealth.
- Out-of-state providers can use telehealth services as long as they are licensed in their state.
The Centers for Medicare & Medicaid Services (CMS) issued guidance allowing the below adjustments within the Medicaid program during COVID-19. States must apply for a Section 1135 waiver to implement these measures.
- Allow health facilities to provide services in alternative settings if they reach capacity during the pandemic.
- Streamline provider enrollment by removing the typical requirements for a site visit, application fees, etc.
- Suspend prior authorization requirements for Medicaid fee-for-service (services not provided by a Medicaid health plan).
- Remove rules that limit the number of beds and length of patient stays that are allowed at critical access hospitals.
- Extend the timeline to conduct participant hearings and allow those in managed care to request a hearing with the state Medicaid department instead of waiting for the health plan to resolve.
Missouri has applied for a 1135 waiver with many of the recommended measures and received provisional, temporary approval on March 25, 2020 for the duration of the public health emergency.
The Families First Coronavirus Response Act (H.R. 6201) ensures that patients will not be responsible for cost sharing related to COVID-19 testing. The legislation also directs the federal government to pay for 100% of testing for people who do not have health insurance. Additionally, the federal government will increase funding to Medicaid programs by 6.2% if all the following actions are taken by states.
- Eligibility and premium requirements must remain at January 1, 2020 levels.
- States may not terminate Medicaid coverage until the end of the COVID-19 emergency.
- Cost sharing is not allowed for COVID-19 testing, treatment, vaccines, therapy, equipment, etc.
Missouri has implemented these measures to receive enhanced funding during COVID-19.