Medicaid expansion changed the eligibility requirements for Missouri’s Medicaid program (MO HealthNet) to include adults between the ages of 19 and 64 who are eligible for the program. Missouri voters approved Medicaid expansion, the Supreme Court of Missouri held the expansion amendment to be constitutional, and the trial court ordered the state not to prohibit enrollment.
Per the Cole County Circuit Court’s August 10, 2021 order, individuals could apply for healthcare coverage through MO HealthNet under Article IV Section 36(c) of the Missouri Constitution. The Family Support Division (FSD) began processing adult expansion applications in the Missouri Eligibility Determination and Enrollment System (MEDES) on October 1, 2021.Participants should report all changes that may affect their MO HealthNet coverage online.
- Who became eligible for MO HealthNet coverage due to Medicaid expansion?
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
- Are not eligible for or receiving any of the following:
- MO HealthNet for Pregnant Women
- MO HealthNet for Families
- MO HealthNet for the Aged Blind & Disabled Non-Spenddown
- Medicare Part A or B
MO HealthNet Coverage for Former Foster Care Youth
- What are the income guidelines for the adult expansion group?
Providers can view the income guidelines for the adult expansion group by reviewing the Benefit Program Limit Chart
- What is the adult expansion group's Medical Eligibility (ME) code?
The ME code for the adult expansion group is E2.
- Can providers submit a MO HealthNet application for a participant?
Providers may assist participants by uploading their information to the FSD Upload Portal. There are three ways participants can apply for MO HealthNet benefits. Visit the Apply for MO HealthNet webpage to learn more about how they can apply.
- How will individuals find out if they are approved for coverage?
Once an application is processed, the applicant will get a letter that lets them know whether they are eligible for healthcare coverage. If approved, they will get a MO HealthNet Identification Card and information explaining the type of services and coverage they have. They must follow the instructions in the letter for their coverage to begin.
- If a participant is approved for MO HealthNet coverage and later becomes disabled, what should the participant do?
The participant must report this change to the Family Support Division (FSD) by completing the online Aged, Blind, and Disabled Supplement (IM-1ABDS). This supplement does not meet the requirements of an application for coverage; it is to be completed in addition to the online portal application or by calling the FSD Contact Center at (855) 373-9994.
- If a provider learns a participant has a disability, do they need to send the participant a Medical Review Team (MRT) packet?
An MRT packet is required if an individual has a disability and wants to be considered for MO HealthNet for the Aged, Blind, and Disabled coverage. The participant must report this change to the Family Support Division (FSD) by completing the online Aged, Blind, and Disabled Supplement (IM-1ABDS). This supplement does not meet the requirements of an application for coverage; it is to be completed by the participant in addition to the online portal application or by calling the FSD Contact Center at (855) 373-9994.
- If an applicant was not born in Missouri, will they be required to submit a birth certificate?
FSD currently needs the ability to verify citizenship electronically for applicants born outside Missouri. If an applicant was born outside Missouri, they can submit documents that prove citizenship with their application. If additional documentation is needed, FSD will request additional verification.
- If a woman is covered through adult expansion and becomes pregnant, will she have to apply for MO HealthNet for Pregnant Women, or will her pregnancy be covered automatically?
If a woman with MO HealthNet coverage becomes pregnant, she should report this change. Once she reports her pregnancy, FSD will determine if she is eligible for coverage through the MO HealthNet for Pregnant Women. Participants covered under MO HealthNet for Pregnant Women are eligible for additional benefits and services, including 12 months of postpartum care. If a woman is eligible for MO HealthNet for Pregnant Women, she will be ineligible for adult expansion coverage until she is no longer pregnant.
- Can a participant add someone to their MO HealthNet case?
Participants can add a new household member to their MO HealthNet case in one of the following ways:
- Report a change online
- Call the Family Support Division (FSD) Contact Center at (855) 373-9994
Visit their local Resource Center
- Since the applications are online, are email addresses required to apply?
No. Email addresses are encouraged but not required.
- What happens if someone not receiving SSDI/SSI has already applied for MO HealthNet for the Aged, Blind, and Disabled but would like to apply for adult expansion coverage instead?
If someone no longer considers themselves disabled, they must notify the Family Support Division (FSD) that they are no longer disabled and would like to explore eligibility for adult expansion by:
- Reporting a change online
- Call the FSD Information Line at (855) 373-4636
Visiting their local Resource Center
- How should providers submit Authorized Representative forms or supporting documentation for participants?
Providers should submit relevant forms and documents using the FSD Upload Portal.
- Will unborn children count as household members?
No, an unborn child is not considered a dependent.
- How can a participant report a change in their employment or income?
Participants should report all changes that may affect their MO HealthNet coverage online.
- If a participant needs assistance applying for MO HealthNet coverage, what should they do?
Individuals should use the Appointing an Authorized Representative form if they would like to name someone or an organization to help them apply for MO HealthNet coverage
- Will a child age 19 to 21 need to apply for adult expansion coverage when they age out of MO HealthNet for Families?
No. The Family Support Division (FSD) will complete an ex-parte and explore eligibility for adult expansion coverage when the individual turns 19.
- How will the Family Support Division (FSD) handle households who report $0 income?
FSD must use all electronic sources to verify an individual’s income. If no income is verified, FSD will proceed with the review.
- 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.
- What is the Medicaid program hierarchy for those ages 19 to 64?
Coverage under MO HealthNet for Families, MO HealthNet for the Aged, Blind, and Disabled (non-spenddown), and MO HealthNet for Pregnant Women must be explored before eligibility for Adult Expansion. Adult expansion coverage will be explored if the individual does not meet the criteria for these programs.
- Will there be an annual review period for individuals with adult expansion coverage?
Yes. Individuals must complete an annual review each year they have MO HealthNet coverage to ensure they are still eligible.
- If the pregnancy is covered through adult expansion, will the child be automatically eligible for a year like they are now?
Yes. If a woman with MO HealthNet coverage becomes pregnant, she should report this change. Once she reports her pregnancy, FSD will determine if she is eligible for coverage through the MO HealthNet for Pregnant Women program. Participants covered under MO HealthNet for Pregnant Women are eligible for additional benefits and services, including 12 months of postpartum care. If a woman is eligible for MO HealthNet for Pregnant Women, she will be ineligible for adult expansion coverage until she is no longer pregnant.
- What services will be covered for those receiving adult expansion coverage?
Please refer to our list of covered services for more information
- How will Medicaid expansion impact the Health Insurance Premium Payment Program (HIPP)?
The HIPP Program helps pay for the cost of health insurance premiums for certain MO HealthNet participants. The program pays for health insurance for MO HealthNet participants when it is cost-effective (meaning that it costs less to buy health insurance to cover medical care than to pay for the same services with MO HealthNet funds). Whether or not a participant is eligible for the HIPP Program will be explored as it is with all other MO HealthNet programs.
- Will MO HealthNet participants be able to choose their Managed Care Health Plan?
Yes. The process for the adult expansion group will be the same as any other Medicaid program covered through Managed Care.
- When does coverage begin after someone applies?
Once approved, MO HealthNet coverage begins on the first day of the month the person submits their application. If prior quarter coverage was requested, coverage may begin the first day of the month from when they were first eligible
- When a 19-year-old ages out of MO HealthNet for Families and their parents are already covered through adult expansion, will they be covered under their parent’s active expansion case or will they need to apply for adult expansion coverage with their own application? If they will be placed on their parents’ application, will that only be until the age of 26, like commercial insurance?
Adult expansion coverage will be explored as part of the ex-parte process. If the 19-year-old is a dependent on their parents’ taxes, the parents will be included in the household. If the 19-year-old is not a dependent, they will be considered their own household. The adult expansion coverage follows the same household composition as MO HealthNet for Families and MO HealthNet for Kids. Household composition is based on the tax filing status
- Are out-of-state students attending college in Missouri eligible for Medicaid if they meet the other requirements?
Yes. When they apply, they should provide their current Missouri address on their application
- How did Medicaid expansion affect seniors or individuals with a disability?
Medicaid expansion did not impact them if they already had MO HealthNet coverage; however, if they did not have coverage through MO HealthNet, the application process changed.
Seniors or individuals with disabilities who want to apply for MO HealthNet coverage should apply through the online portal, by phone at (855) 373-9994, or by completing the application. For additional information, participants should visit Apply for MO HealthNet.
- Can someone with health or limited benefit insurance qualify for coverage through Medicaid expansion?
Yes. Anyone who meets the eligibility requirements may qualify for coverage through MO HealthNet.
- Will coverage through Medicaid expansion be explored before coverage through MO HealthNet for the Aged, Blind, and Disabled if a Medical Review Team (MRT) decision is needed? If so, and if they are approved for coverage through adult expansion, will MO HealthNet for Aged, Blind, and Disabled continue to be explored if requested?
Yes. Individuals with a disability requiring an MRT decision will be considered for adult expansion coverage and approved if eligible. The individual must request the MRT decision before eligibility can be determined. MO HealthNet for the Aged, Blind, and Disabled will also be explored to determine if the individual is non-spend down eligible. If they are, the adult expansion group will be closed due to eligibility in a mandatory group. If an individual qualifies for MO HealthNet coverage through Spend Down or Ticket to Work, they can choose between the programs.
- Will moms who are moving off of the 12 months of postpartum coverage be moved to adult expansion coverage if their income is within limits?
Yes.
- Suppose an applicant for MO HealthNet for the Aged, Blind, and Disabled is denied due to verification/failure to cooperate. Will they remain ineligible for coverage until they cooperate with previous requests?
Yes. FSD will automatically explore eligibility for adult expansion coverage until the MO HealthNet for Aged, Blind, and Disabled (MHABD) is complete. If the individual fails to cooperate or provide the required resources, then the MHABD will reject it; however, the individual will remain eligible for adult expansion coverage as long as they meet the eligibility requirements. If they fail to cooperate and verify those requirements, they will be ineligible for coverage through either program.
- Are paroled felons in Missouri eligible for adult expansion coverage?
Anyone who meets the eligibility requirements may be eligible for MO HealthNet coverage.
- Is there an asset limit for adult expansion coverage?
No.
- Will the Family Support Division consider the 5% disregard?
Yes. The 5% disregard will be applied like it is in other MO HealthNet programs. This means that the system will run a determination on individuals who have an income. If they are ineligible for coverage due to their income, the system will run a second determination that applies the 5% disregard.
- Will there be presumptive eligibility (PE) for expansion?
Yes, for hospitals, Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), Comprehensive Substance Treatment and Rehabilitation (CSTAR) facilities, and Community Mental Health Centers (CMHCs) only.
Revised October 2024