FAQs about Applying for MO HealthNet (Missouri Medicaid)
If you do not have health insurance or need help paying for your health care, you may be eligible for coverage through Missouri’s Medicaid program, called MO HealthNet. Eligibility for MO HealthNet coverage depends on your income, age, health, and individual needs. Review the eligibility requirements to determine your eligibility.
To determine if you are eligible and to apply, visit Apply for MO HealthNet. You can apply through the online portal, by phone at (855) 373-9994, or download and print the application using Adobe Reader.
If you are approved for MO HealthNet coverage, you will either be assigned to a Managed Care health plan or you will receive Fee for Service coverage. You may be eligible for MO HealthNet coverage if you are a(n):
Fee-For-Service
- Senior (age 65 and older)
- Person with a disability
- Blind or visually impaired adult
- Woman (under age 65) with breast or cervical cancer
Managed Care
- Pregnant woman including her newborn
- Child (birth to age 18)
- Parent with children in the home
- Adult (age 19-64) without a disability
- What services does MO HealthNet cover?
MO HealthNet covers services that help you live a long and healthy life. Services are meant to prevent and treat illness and correct or limit disability.
The following are some examples of covered services. Services may be limited or not covered based on your eligibility.
- Ambulance
- Ambulatory surgical center
- Behavioral health services
- Birthing centers
- Comprehensive day rehabilitation
- Dental
- Diabetic supplies and equipment
- Diabetes self-management training
- Doctor’s office visits
- Durable medical equipment (oxygen, wheelchair, walker)
- Healthy Children & Youth Program
- Emergency room
- Family planning
- Hearing aids and related services
- Home health services
- Hospice, in the last six months of life
- Hospital, when overnight stay is required
- Laboratory tests and x-rays
- Maternity benefits, nurse midwife
- Mental health and substance abuse
- Nursing Facility
- Outpatient, when overnight stay is required
- Personal care
- Podiatry
- Pharmacy
- Transplant and related services
- Transportation to medical appointments
- Vision
Additional information can be found on the Covered Services chart.
- What happens after I apply for MO HealthNet?
Once you have applied, the Family Support Division (FSD) will let you know what might be needed to process your application. The time it takes to process your application may vary, and if FSD has to make an eligibility decision based on a disability, it may take longer than usual. If you do not receive anything from FSD after 45 days, you can Contact FSD.
Once your application has been processed, you will receive a letter from FSD that lets you know if you are eligible for MO HealthNet coverage. If you are approved, you will receive a MO HealthNet Identification Card and information explaining the type of services and coverage you have. You will need to follow the instructions in the letter in order for your coverage to begin.
If you are enrolled in a MO HealthNet Managed Care health plan, you will get an assignment letter in the mail about the health plan you were assigned to and the date your services will begin. You can start getting care once you receive your assignment letter.
Your new health plan will send you a welcome packet, a Managed Care health plan card, and a member handbook with information about your services. Always carry both your Managed Care health plan and your MO HealthNet ID cards with you and show them each time you get care. Call the phone number on your health plan card if you have any questions about your health plan.
- How can I check the status of my application or ask questions about my coverage?
You can receive assistance in the following ways:
- Online: Visit mydss.mo.gov to apply for benefits, check your status, report a change, or learn more about MO HealthNet coverage
- Call: (855) 373-4636
- Chat Online: Visit mydss.mo.gov and select DSS Chat to get answers about your case or general information
- In Person: Visit your local FSD Resource Center
- Text: For answers to basic questions that are not case-specific, Monday through Friday from 6:00 am to 6:00 pm, text (855) 684-9242.
- Do I have to be in a Managed Care health plan?
You may choose to opt-out, or not enroll in a Managed Care program if you meet one of the following conditions:
- Eligible for Supplemental Security Income (SSI) benefits
- Children who are enrolled in the Special Health Care Needs program
- Disabled and 18 or younger
Call the Managed Care Enrollment helpline at (800) 348-6627 or the Family Support Information Center at (855) 373-4636 for assistance.
- I am receiving Medicare. Can I also receive MO HealthNet? How do they work together?
Yes, you can receive both Medicare and MO HealthNet coverage. Medicare is handled at the federal level and MO HealthNet is handled at the state level.
If you receive both, Medicare is the primary. This means Medicare will be billed first. MO HealthNet will be billed last and will pay the coinsurance and deductible amounts on Medicare covered services.
If you have chosen a Medicare Advantage Health Plan, also called Part C, for your Medicare coverage, MO HealthNet will only pay coinsurance or deductible payments if you are also enrolled in the Medicare Savings Program under Qualified Medicare Beneficiary (QMB). MO HealthNet will not assume responsibility for the Medicare coinsurance and deductible amounts for Medicare Advantage Health Plan/Part C without being eligible for QMB.
MO HealthNet will not pay the Medicare coinsurance and deductibles for Nursing Home Room and Board or Inpatient Room and Board charges.
The different Medicare plans are explained in the Medicare Savings Program section of the Fee For Service Participant Handbook.
- What if I am approved for MO HealthNet and also have private insurance?
If you have other insurance, we need to know.
The provider must bill your private insurance before billing MO HealthNet Fee-For-Service or the Managed Care plan.
It is important to keep your insurance information up to date. If you have a change, enroll with private insurance, or if you no longer have private insurance, you need to report the change in one of these ways:
- Report a change online (For assistance, watch this short video)
- Call the Family Support Division at (855) 373-4636
- Visit your Family Support Division local office
To determine if your private insurance is already on file with MO HealthNet, call (800) 392-2161, option 2, and enter the eight-digit MO HealthNet number found on your MO HealthNet ID Card.
If you’re assigned to a Managed Care Health plan, you can also call the Managed Care Enrollment helpline at (800) 348-6627 for additional assistance.
MO HealthNet may be able to help pay your private insurance plan premiums and copays through the Health Insurance Premium Payment (HIPP) Program. For more information about the HIPP Program, contact the Cost Recovery Unit at (573) 751-2005 or email MHD.HIPP@dss.mo.gov.
- If I am approved for MO HealthNet, do I have to pay a premium?
Based on your family’s income and family size, you may need to pay a monthly premium. The letter you get from the Family Support Division about your eligibility will tell you if you need to pay a premium prior to your coverage beginning. If you have any questions about premiums, call (877) 888-2811.
You may not be required to pay a premium if your child is a member of a federally-recognized American Indian or Native Alaskan tribe and you provide proof of membership. For more information, refer to the MO HealthNet Guide to Managed Care.