Missouri Medicaid Income Limits 2020


Who Was Behind The Campaigns Surrounding Amendment 2

Legal Lens: Understanding Missouri’s Medicaid expansion controversy
See also: Support and Opposition

Healthcare for Missouri led the Yes on 2 campaign in support of the amendment. There were two political action committees, Healthcare for Missouri and Missourians for Healthcare, registered to support Amendment 2. The committees raised $10.7 million, with Missourians for Healthcare receiving the bulk of the contributions. The top five donors to the campaign included the Missouri Hospital Association, the North Fund, the Health Care Issues Committee of the Missouri Hospital Association, the Health Forward Foundation, and The Fairness Project.

The support campaign argued that the coronavirus pandemic has shown the need for Medicaid expansion. Jack Cardetti, a spokesperson for the Yes on 2 campaign, said, “Now more than ever, Missourians need to be able to access care in their own communities and protect thousands of local frontline healthcare jobs. … Amendment 2 will help keep rural hospitals and urban clinics open by bringing $1 billion of our own tax dollars back from Washington, instead of going to the 37 other states that have expanded Medicaid.”

Other Mo Healthnet Programs

When you apply for MO HealthNet, we will also check to see if you can get help through:

  • Spend Down: If you make too much money, you may still be able to get MO HealthNet coverage if you agree to pay, or spend down, a certain amount. Once you spend this amount, you will have MO HealthNet coverage for the month. For more information visit our frequently asked questions.
  • Ticket to Work: If you are disabled and make too much money to qualify for MO HealthNet, you can still get help with your healthcare costs if you agree to take part in this program. Learn more about Ticket to Work.
  • Home & Community Based Services: These services may be able to help you or a loved one stay at home and out of a nursing home by providing the in-home services you need.
  • MO HealthNet Nursing Home Coverage: If you live in a nursing home, we may be able to help pay for any nursing home costs you arent responsible for. You will be responsible for using all of your income towards costs except for a $50 monthly allowance, any health insurance premiums, and any income set aside for a spouse or other dependents.

NOTE: There is no separate application process for these programs. You will automatically get more information if your MO HealthNet application shows you are eligible.

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Medicaid For Children And Adults

Eligibility for Medicaid and Dr. Dynasaur are based on the current year Federal Poverty Level guidelines.

  • The monthly income limit for adults ages 19 through 64, who are not blind or disabled, is 138% FPL.
  • The monthly income limit for children under age 19 is 317% FPL. . There is a monthly premium for some households based on your income. For families up to 195% FPL, there is no premium. There are no prescription co-payments.
  • The monthly income limit for Vermonters who are pregnant is 213% FPL. Dr. Dynasaur for pregnant women provides the same coverage as Medicaid, plus full dental coverage. There are no premium or prescription co-pays with this type of Dr. Dynasaur.

What Happens After I’m Approved

Income Limit For Medicaid Mo

After you are approved, a MO HealthNet ID card will be mailed to you. If you are assigned to a MO HealthNet Managed Care Health Plan, you will also get your health plan card in the mail. You will need to bring all of your healthcare ID cards to each of your appointments.

Next, you will need to find a health care provider that accepts your MO HealthNet coverage :

  • If you have a Managed Care health plan, you can search for a provider through your plan
  • If you do not have a Managed Care health plan, you need to find a provider that accepts MO HealthNet

If your health care provider does not accept your healthcare coverage, you will need to choose a new provider or a new Managed Care health plan.

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How Long Does It Take The State To Process Applications

The federal governments public health emergency, or PHE, has eliminated loads of work for those administering Medicaid by allowing for continuous enrollment in the program, meaning redeterminations of a patients eligibility have not been required since January 2020. Once the PHE expires, most of Missouris 1.2 million Medicaid recipients will have to go through the redetermination process.

It could expire at any point, but states will have 60 days notice before the change is made. Officials expect to hear about whether the PHE will be extended by mid-August. If it is, the extension will likely last another quarter, they said Wednesday.

Sheldon Weisgrau, vice president of health policy at the Missouri Foundation for Health, said he is worried as the state prepares to pick up eligibility checks and workloads that havent been necessary for months.

I think all of us that work in Medicaid policy are very concerned about how thats going to happen, given what were seeing currently with enrollment, how the state is going to continue to try to enroll people into Medicaid, and at the same time redetermine eligibility for everybody that is currently in the program, Weisgrau said. I think were all really worried about how thats going to work out.

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Weisgrau added that he fears plenty of Missourians who are eligible to receive coverage will be taken off the program because they didnt update information.

What Is The Lowest Income To Qualify For Medicaid

There are 13 states that do not grant Medicaid access to individuals based on income alone.

Of those that do, only Wisconsin uses a limit lower than 138%. An individual in Wisconsin can make no more than the federal poverty level in order to qualify for Medicaid.

Texas has the lowest income limit to qualify on a family basis, at 17% of the FPL. A two-parent household with one child in Texas can make no more than $37,332 and qualify for Medicaid.

The Missouri Medicaid Income Limit is calculated as a percentage of the Federal Poverty Line.

To qualify, you must meet the Missouri Medicaid Income limits listed below.

Here is the Federal Poverty Level for 2021.

2021 Federal Poverty Levels for the 48 Contiguous States & D.C.
Household Size

Additionally, to be eligible for Medicaid, you cannot make more than the income guidelines outlined below:

  • Children up to age 1 with family income up to 196 percent of FPL
  • Any child age 1-5 with a family income up to 150 percent of FPL
  • Children ages 6- 18 with family income up to 150 percent of FPL
  • CHIP for children with family income up to 300 percent of FPL
  • Pregnant women with family income up to 196 percent of FPL
  • Parents of minor children with family income up to 17 percent of FPL
  • Individuals who are elderly, blind, and disabled with family income up to 87% of the FPL

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What Other States Have Voted On Medicaid

See also: Medicaid expansion in 2018

In 2017, Maine was the first state to vote on a ballot initiative to expand Medicaid. Maine’s 2017 measure was approved. In 2018, ballot initiatives to expand Medicaid in Utah, Nebraska, and Idaho were approved. A 2018 initiative in Montana that would have renewed Medicaid expansion and increased tobacco taxes was defeated. On June 30, 2020, Oklahoma approved an initiative to expand Medicaid. It was approved 50.5% to 49.5%.

Missouri Has Missed Out On Billions In Federal Funding

Will Oklahoma’s state budget fund Medicaid expansion?

In states that expand Medicaid, the federal government paid the full cost of expansion through 2016. Starting in 2017, the states gradually started to pay a share of the expansion cost, and states now pay 10% of the cost . Because of the generous federal funding for Medicaid expansion, states that reject it are missing out on billions of federal dollars that would otherwise be available to provide healthcare in the state.


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How To Get Medicaid

Since Medicaid programs are state-managed, eligibility requirements vary from state to state. Your eligibility for Medicaid coverage depends in part on whether the state you live in has adopted the expanded program. In all states, you may qualify for Medicaid based on your household size, income, family status, and disability, among other factors.

In states that run an expanded Medicaid program , your income alone level can qualify you for coverage. Your family may be eligible for Medicaid if your current household income is at or below the 2021 100% federal poverty level.

The federal government sets income limits every year to define the federal poverty level for different households. Children between 1 and 6 years are eligible for Medicaid benefits when the household income doesnt exceed 133% of the federal poverty level. Pregnant women and infants younger than one year are eligible for Medicaid with a family income not exceeding the 200% federal poverty level. Pregnant women are factored as two family members.

Depending on how your household income is calculated, some states will use an income limit at or below 138% of the federal poverty level.

Not every low-income individual is eligible for Medicaid. In states that are yet to implement the Affordable Care Act Medicaid expansion, adults over 21 are often ineligible for Medicaid no matter how low their incomes are. Exceptions include when theyre pregnant, elderly, caring for children, or have a disability.

Does Missouri Help With My Medicare Premiums

Many Medicare beneficiaries who struggle to afford the cost of Medicare coverage are eligible for help through a Medicare Savings Program . In Missouri, these programs pay for Medicare Part B premiums, Medicare Part A and B cost-sharing, and in some cases Part A premiums.

  • Qualified Medicare Beneficiary : QMB pays for Part A and B cost sharing, Part B premiums, and if a beneficiary owes them it also pays their Part A premiums. The income limit is $1,083 a month if single or $1,457 a month if married.
  • Specified Low Income Medicare Beneficiary I : SLMB pays for Part B premiums. The income limit is from QMB levels up to $1,296 a month if single or $1,744 a month if married.
  • Specified Low Income Medicare Beneficiary II : QI pays for Part B premiums. The income limit is from SLMB levels up to $1,456 a month if single or $1,960 a month if married.
  • Qualified Working Disabled Working Individuals : The income limit is $2,126 a month if living alone and $2,873 a month if living with one other person. QDWI pays the Part A premiums for certain disabled beneficiaries who have returned to work.

MSP asset limits: The asset limit for QMB, SLMB and QI is $7,860 if single and $11,800 if married.

Missouri doesnt count the first $20 of each applicants unearned income when determining their eligibility for an MSP or Medicaid ABD.

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How Is Amendment 2 Related To The Affordable Care Act

See also: Medicaid expansion under the ACA

Medicaid is a government program that provides medical insurance to groups of low-income people and individuals with disabilities. The Affordable Care Act , also known as Obamacare, provided for the expansion of Medicaid to cover all individuals earning incomes up to 138 percent of the federal poverty level. In 2012, the U.S. Supreme Court ruled in NFIB v. Sebelius that the federal government could not withhold funds from states that refused to expand Medicaid. The ruling had the practical effect of making Medicaid expansion optional for states. For 2020 and subsequent years, the federal government was set to cover 90 percent of the costs. As of 2020, a total of 37 states and Washington, D.C., had expanded or voted to expand Medicaid, while 13 states had not.

Can I Get A Ride To My Appointments

UPDATED: How many could lose coverage in your CONGRESSIONAL DISTRICT ...

If you have an appointment with your healthcare provider and you need a ride, you may be able to get one through Non-Emergency Medical Transportation. To see if you can get a ride, you will need to contact your Managed Care health plan. If you do not have a Managed Care health plan, please call . You will need to call at least 3 days before your appointment to arrange a ride .

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What Does Medicaid Cover In Missouri

Each Medicaid program in Missouri has specific coverage limits and people who qualify receive a letter explaining what their plan covers.

Its especially important for people with fee-for-service plans to know which services their plan covers because they all differ. To verify eligibility for a specific service, call the MO HealthNet Participant Services Unit at 1-800-392-2161.

Missouri Medicaid has three different providers within its managed care plan United Health Care, Home State Health, and MissouriCare. Each program is required to have the exact same services and coverages so choose your plan based on which option your doctor accepts. The coverages include, but arent limited to:

  • Primary care services
  • Specialty care with a referral from your primary care physician
  • Family planning services
  • Behavioral health and substance abuse services

Are There Options If I Make More Than The Limit

There might be some options to still receive Medicaid benefits if you make more than the income limit in your state.

The options do differ from state to state, but the majority do offer a pathway for those who would be considered medically needy and have high medical expenses.

If someone who requires a lot of medical care has too high of an income, they might be able to spend that income on their medical costs and then have that count against their income.

For example, if someone was $500 over the income limit in their state and that state has a program for the medically needy, they might be permitted to spend that excess income on their medical expenses and then receive Medicaid benefits after. This helps those with high than average medical costs be put on more equal footing for income eligibility requirements.

Not every state offers this particular program, however. For a great resource on the sorts of waivers, exceptions, and other eligibility information, visit this website. Once you click on your state of residence, you should be able to see which waivers are available in your state for those who exceed the income limit.

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What Is Spend Down

MO HealthNet for the Elderly, Blind, and Disabled with a Spend Down allows consumers who have income above the income level for MO HealthNet for Disabled to qualify for coverage. The Spend Down amount is the amount of income that is above the income maximum. For 2020 the income limit for the elderly and disabled is $885 for an individual and $1,198 for a couple.

MO HealthNet for the Elderly, Blind, and Disabled Income Deductions

The following income deductions are allowed:

  • The first $65 of earned income
  • One-half of remaining earned income
  • A $20 personal income exemption
  • All SSI payments
  • Health insurance premiums
Spend Down Calculator

This tool can be used to see how different earned income amounts impact the consumer’s premium and eligibility for the Ticket to Work Health Assurance program.

Unlike a premium the Spend Down can be met in different ways:

How To Sign Up For Medicaid

Local Matters: Missouri Republicans block funds for Medicaid expansion

Missouri residents can sign up for Medicaid either online, by phone, through the mail, or in person at a designated Medicaid office. The online application is one of the more popular options for applicants to use, but all three of these application processes are available. Applicants should make sure that they qualify and have the required documents available before starting their Medicaid application.

No matter how you apply for Medicaid, you will need to submit the following documents and information along with your Medicaid application form:

â Proof of United States citizenship

â Proof of Missouri residency

â Income statements

â Social security number

â Current living address

â Phone number

â The number of people in your household

For people who are applying for Medicaid not only for themselves, but also on behalf of their family, they will need to submit the above information for every family member that they are applying for. A separate Medicaid application may need to be completed for each family member as well. If you have questions about applying for yourself and your family members, contact a Medicaid office close to you and ask to speak with an Authorized Representative.

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