Who is eligible for
Missouri Medicaid?
Medicaid/MC+ Eligibles
In Missouri there are many federal and state funded programs available to
individuals who meet basic categorical eligibility criteria. Medicaid refers
to the statewide fee-for-service (FFS) medical assistance program for
elderly and disabled individuals. MC+ refers to the statewide medical
assistance program for low-income families, pregnant women and children. MC+
individuals receive their care through either the FFS delivery system or the
Managed Care delivery system, depending on where the individual lives in the
state. Medicaid/MC+ benefits are available to those persons who are
determined eligible for the following types of assistance.
MC+ For Children
Infants under the age of one whose family income is less than 185% of
the federal poverty level may be eligible; children under the age of six at
133%; and children ages six through eighteen at 100%. MC+ for Kids,
Missouri’s State Children’s Health Insurance Program (SCHIP) (1115
Demonstration Waiver) – Uninsured children with gross family income up to
300 percent of the federal poverty level. “Uninsured Children” are persons
under nineteen years of age who have not had employer-subsidized health care
insurance or other health care coverage for six months prior to application.
Missouri Medicaid Site
Medical Assistance for Families (MAF)
The Personal Responsibility and Work Opportunity Reconciliation Act of
1996 (P.L. 104-193) eliminated the AFDC program delinking receipt of cash
from Medicaid and replaced it with Section 1931 of the Social Security Act
to provide Medicaid to low-income families with children.
Transitional Medical Assistance (TMA)
Provides MC+ healthcare coverage (Medicaid) to a family for up to 12
months, after the closing of MAF case due to employment or increased
earnings.
MC+ for Pregnant Women
This program is intended to provide Medicaid services to low-income
pregnant women. A woman whose family income does not exceed 185% of poverty
may qualify.
Extended Women’s Health Services (1115 Demonstration Waiver)
Up to 12 months of women’s health services for women who lose MC+
healthcare coverage two months after a pregnancy ends. Coverage is limited
to family planning, and testing and treatment of Sexually Transmitted
Diseases.
Newborn
Automatic Eligibility — Newborns are automatically eligible for
assistance if their mother is receiving a federally matched category of
assistance at the time of birth (except TEMP - See Presumptive Eligibility
for Pregnant Women).
Medical Assistance (MA)
(Spenddown and Non-Spenddown) — Medicaid coverage for persons who meet
the requirements of: Old Age Assistance (OAA); Permanently and Totally
Disabled (PTD) and Aid to the Blind. -- Persons must be over age 65 or meet
the Supplemental Security Income (SSI) definition of disabled or the state
definition of blindness. Persons receiving Supplemental Security Income (SSI)
or Social Security based on age or disability are automatically qualified
for Medical Assistance on those factors. Persons determined by Social
Security to meet 1619 A or B status are eligible as non-spenddown.
Medical Assistance for Disabled Children
A disabled child may be eligible for Medical Assistance. The income and
resources of the parents are taken into consideration.
Supplemental Nursing Care
Provides a state grant and Medicaid to elderly, blind, and disabled
persons in licensed residential care facilities and non-Medicaid nursing
homes.
Supplemental Aid to the Blind
Provides assistance to needy blind persons.
Qualified Medicare Beneficiary
Pays for Medicare premiums, deductible and coinsurance for eligible
persons enrolled in Medicare part A with income up to 100% of poverty.
Specified Low Income Medicare
Beneficiary
Provides payment of Medicare Part B premiums to individuals who would be
eligible for the Qualified Medicare Beneficiary program except for excess
income. Income must be more than 100% of the Federal Poverty Level, but not
exceed 120%.
Psychiatric Services 21 years and under
Provides assistance to individuals under 21 in a psychiatric facility.
IV/E Alternative Care
Provides assistance to children in the Children’s Division’s (CD) foster
care and adoptive homes.
Homeless, Dependent, Neglected Children — Provides assistance for children
in care and custody of the Children’s Division (CD).
Medical Assistance for Children in Care
Children in the custody of Division of Youth Services (DYS) or a
juvenile court.
Breast and Cervical Cancer Treatment Program — Medicaid coverage for
uninsured women under age 65 screened for breast or cervical cancer by
Missouri’s Breast and Cervical Cancer Control Project (BCCCP). (Note: The
BCCCP Program has requirements including income limits that must be met to
get the screening.)
Refugee Assistance
Persons who are admitted to the United States with an immigration status
of refugee or asylum may qualify for a short period of time in order to
establish self–sufficiency if they do not meet eligibility for another
category.
Presumptive Eligibility for Pregnant Women (TEMP) — Pregnant women may be
determined eligible by qualified providers for temporary eligibility during
pregnancy until they can apply for and begin receiving full Medicaid
benefits.
Presumptive Eligibility for Children
Provides a period of presumptive eligibility to children in families
with income below 225% of the Federal Poverty Level. Children under the age
of 19 may be determined eligible by qualified entities for Medicaid on a
temporary basis prior to having a formal eligibility determination
completed.
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