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More Than 17000 People Had Applied For Expanded Medicaid By Early October Enrollments Being Processed As Of October And Coverage Can Be Backdated To July 1 2021

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As described below, Missouri had a long and somewhat complicated road to Medicaid expansion. But as of October 2021, Medicaid expansion in the state was fully in effect, and more than 17,000 people had already applied for coverage.

Applications are being accepted for adults under age 65 with household incomes up to 138% of the poverty level. In 2021, that amounts to about $17,774 for a single individual, and $36,570 for a household of four . This is eventually expected to result in 275,000 Missouri residents becoming eligible for MO HealthNet.

The state has clarified that applications submitted by November 1, 2021 can have coverage backdated to July 1, 2021, which is when Medicaid expansion would have taken effect if lawmakers hadnt blocked funding during the spring 2021 legislative session.

The federal government is paying 90% of the cost of Medicaid expansion in Missouri, just as they do in other states that have expanded Medicaid. But since Missouris expanded eligibility rules took effect after the American Rescue Plan was enacted, the state is also receiving an increase of 5 percentage points added to its regular federal matching rate for the traditional Medicaid population, for the next two years .

Where Can Medicare Beneficiaries Get Help In Missouri

Missouri State Health Insurance Assistance Program

Free volunteer Medicare counseling is available by contacting the Missouri State Health Insurance Assistance Program at 800-390-3330. The SHIP program in Missouri is called CLAIM.

The SHIP can help beneficiaries enroll in Medicare, compare and change Medicare Advantage and Part D plans, and answer questions about state Medigap protections. SHIP counselors may also be able to offer referrals to local agencies for services like home care and long-term care. The SHIPs website has more information on services it offers.

Elder Law Attorneys

Elder law attorneys can help individuals plan for Medicaid long-term care benefits. You can use this National Academy of Elder Law Attorneys search feature to find an elder attorney locally.

Missouri Area Agencies on Aging

Medicare beneficiaries in Missouri can also receive help from Area Agencies on Aging . These organizations can provide information about services that help with aging or living with a disability, and assist with planning for long-term care needs. Here is a list of AAAs in Missouri.

What Is The Income Limit For Missouri Medicaid

Individuals who qualify for the federal Supplemental Security Income program who are disabled according to the SSI guidelines are eligible for Missouri Medicaid as long as their income doesnât exceed certain levels. For disabled individuals, income should not exceed 85% of the Federal Poverty Level . For blind individuals, income should not exceed 100% of FPL. Some disabled individuals may also qualify to receive MO HealthNet financial assistance to pay for Medicare premiums, deductibles, and copayments.

The elderly can sometimes spend down their incomes or medical expenses in order to meet the Medicaid income requirements in Missouri. âSpending downâ is a term that refers to the amount of medical expenses that a person must pay monthly in order to become eligible for Medicaid coverage. An individual or couple may need to spend down their income so that their net income is equal to or lower than the income eligibility requirement for the Missouri Medicaid program.

âSpending downâ to meet income eligibility requirements may include either of the following:

â Monthly submission of medical expenses to a caseworker

â Monthly payments of the spend down amount to the MO HealthNet Division

MO HealthNet may also provide assistance to some seniors to pay their Medicare premiums, deductibles, and copayments.

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Helpful Resources For Medicare In Missouri

Missouri Medicare Savings Programs: Paying Part A and Part B premiums and deductibles can be difficult for some beneficiaries. If you have Medicare in Missouri, you can apply for programs that help by offering discounts to low-income beneficiaries. To learn more and apply, visit the Missouri Department of Social Services.

Missouri State Health Insurance Counseling and Assistance Program : Community Leaders Assisting the Insured of Missouri is the official State Health Insurance Assistance Program in Missouri. CLAIM provides free, unbiased information to help Missourians get the most from their Medicare benefits.

Medicare information is everywhere. What is hard is knowing which information to trust. Because eHealths Medicare related content is compliant with CMS regulations, you can rest assured youre getting accurate information so you can make the right decisions for your coverage. Read more to learn about our Compliance Program.

Medicaid Facilitates Access To Care

2010 Form MO IM

A large body of research shows that Medicaid beneficiaries have far better access to care than the uninsured and are less likely to postpone or go without needed care due to cost.

Moreover, rates of access to care and satisfaction with care among Medicaid enrollees are comparable to rates for people with private insurance.

Medicaid coverage of low-income pregnant women and children has contributed to dramatic declines in infant and child mortality in the U.S.

A growing body of research indicates that Medicaid eligibility during childhood is associated with reduced teen mortality, improved long-run educational attainment, reduced disability, and lower rates of hospitalization and emergency department visits in later life.

Benefits also include second-order fiscal effects such as increased tax collections due to higher earnings in adulthood.

Research findings show that state Medicaid expansions to adults are associated with increased access to care, improved self-reported health, and reduced mortality among adults.

Gaps in access to certain providers, especially psychiatrists, some specialists, and dentists, are ongoing challenges in Medicaid and often in the health system more broadly due to overall provider shortages, and geographic maldistribution of health care providers.

Medicaid covers people who are struggling with opioid addiction and enhances state capacity to provide access to early interventions and treatment services.

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Medicaid Covers A Broad Range Of Health And Long

Medicaid covers a wide range of services to meet the diverse needs of the people it helps. Many states choose to cover optional services such as prescription drugs, physical therapy, eyeglasses, and dental care in addition to the federally mandated services.

The ACAs ten essential health benefits, which include preventive services and expanded mental health and substance use treatment services, are included in coverage for Medicaid expansion adults.

Medicaid plays a critical role in combating the opioid epidemic and in connecting Medicaid beneficiaries to behavioral health services in general.

Medicaid provides comprehensive benefits for children, known as Early Periodic Screening Diagnosis and Treatment services.

EPSDT is especially important for children with disabilities because private insurance is often inadequate to meet their needs.

Unlike commercial health insurance and Medicare, Medicaid also covers long-term care including both nursing home care and many homes and community-based long-term services and supports.

More than half of all Medicaid spending for long-term care is now for services provided in the home or community that enable seniors and people with disabilities to live independently rather than in institutions.

Some states have obtained waivers to charge higher premiums and cost-sharing than allowed under federal rules.

Many of these waivers target expansion adults but some also apply to other groups eligible through traditional eligibility pathways.

Who Is Eligible For Medicaid In Missouri

MO HealthNet coverage is available to low-income children and pregnant women. And as a result of Medicaid expansion, its also available to adults under the age of 65 whose household income doesnt exceed 138% of the poverty level.

In addition, low-income residents who are aged, blind, or disabled are also eligible for Medicaid, but theyre also subject to fairly strict asset limits in order to qualify for coverage.

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Medicaid Is Structured As A Federal

States administer Medicaid programs under federal guidelines and have discretion over who is covered, what services are covered, how health care is delivered, and how physicians and hospitals are paid.

States can also get Section 1115 waivers to test and implement approaches that arent required by federal law but that the Secretary of HHS determines are necessary to achieve the programs goals.

As a result of this flexibility, state Medicaid programs differ significantly.

The Medicaid entitlement is based on two guarantees: first, all Americans who meet Medicaid eligibility requirements are guaranteed coverage, and second, states are guaranteed federal matching dollars without a cap for qualified services provided to eligible enrollees.

The match rate for most Medicaid enrollees is determined by a formula in the law that provides a match of at least 50% and provides a higher federal match rate for poorer states.

How Much Money Can You Make To Qualify For Medicaid In Missouri

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All Medicaid-eligible populations are subject to income limits . In Missouri, Medicaid members must have a household income that doesnt exceed the following limits:

  • Adults under age 65: are eligible for Medicaid with household income up to 138% of the poverty level.
  • Infants under one are eligible for Medicaid if their household income is up to 196% of poverty. That amounts to about $43,000 in annual income for a household of three in 2021.
  • Children 1 18 are eligible if their household income is up to 150% of poverty. For a household of three in 2021, that amounts to just under $33,000 in annual income.
  • Children above the Medicaid income thresholds are eligible for CHIP if their household incomes are up to 300% of poverty. This is among the more generous limits in the country.
  • Pregnant women are eligible for Medicaid if their household income does not exceed 196% of poverty .

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Area Agencies On Aging

Missouri has 10 Area Agencies on Aging, each of which serves a designated area of the state. Through your local AAA, you can connect with CLAIM representatives for one-on-one health insurance options counseling. These counselors can help you sign up for Original Medicare or switch back from a Medicare Advantage plan during open enrollment and special enrollment periods. They can also help you understand and settle your medical bills and resolve denied claims or billing errors.

Contact Information: Website | 526-4542

Medigap In Missouri: Extensive Consumer Protections

Medigap plans are used to supplement Original Medicare, covering some or all of the out-of-pocket costs that people would otherwise incur if they only had Original Medicare on its own.There are 50 insurers that offer Medigap plans in Missouri. The state created a helpful Medigap Rate Shopper Tool in 2019 that allows a user to enter some basic information and see prices for the Medigap plans available in their area .

Medigap plans are standardized under federal rules, and there is a six-month window, when people turn 65 and enroll in Original Medicare, during which coverage is guaranteed issue for Medigap plans.

But federal rules do not allow for any sort of annual open enrollment period for Medigap , nor to federal rules guarantee access to a Medigap plan if youre under 65 and eligible for Medicare as a result of a disability.

So in most states, people do not have a chance to switch to a new Medigap plan on a guaranteed-issue basis after their initial enrollment window ends. But Missouris anniversary rule allows enrollees an annual opportunity to change from one Medigap insurer to another on a guaranteed-issue basis during a window that starts 30 days before the plan anniversary date and continues for 30 days after it. So theres essentially a two-month period each year during which people with Medigap coverage can switch to a different Medigap plan . This window is different for each enrollee, since its based on the date they initially got their plan.

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Medicare Spending In Missouri

In 2018, Original Medicare spent an average of $10,205 per beneficiary in Missouri . The national average that year was $10,096 per enrollee, so Medicare spending in Missouri was essentially the same as the national average. At either end of the spectrum, Louisiana had the highest average per-beneficiary Medicare costs, at $11,932, and Hawaii had the lowest, at $6,971.

Can You Get Help Paying For Medicare Parts A And B

Missouri Disability Benefits

While Medicare offers good coverage, it is not as low-cost as MO HealthNet. Depending on the care you need, you may have to pay large copayments, co-insurance, or deductibles. And, for Part B, you may have to pay a monthly premium .

However, if you have low income and low resources, you may qualify for a Medicare Savings Program . Missouri offers three Medicare Savings Programs:

  • The Qualified Medicare Beneficiary program helps people with countable income thats 100% of the Federal Poverty Guidelines or less . QMB pays all Medicare cost-sharing, including your Part B premium, copayments, and deductibles.
  • The Specified Low-Income Beneficiary program helps people with countable income thats more than 100% of FPG, but at or below 120% of FPG . SLMB pays for the Part B premium, but does not help with anything else.
  • The Qualified Individual program, also called SLMB-2 in Missouri, helps people with countable income thats more than 120% of FPG, but at or below 135% of FPG . QI pays for the Part B premium, but does not help with anything else.

For MSPs, less than half of your earned income is counted. That means you might qualify even if you think your income is over the limits.

Federal Poverty Guideline
Your Countable Income as a Percent of FPG

The resource limit for QMB, SLMB, and QI is $7,970 if you live alone and $11,960 if you live with your spouse.

To apply for an MSP, , complete it, and sign and date it, then:

Learn more about Medicare Savings Programs in Missouri.

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Medicaid Eligibility In Missouri

Medicaid is a federal- and state-funded health insurance program that works for low-income individuals, families, and seniors who otherwise wouldnt be able to afford health care coverage. Missouris Medicaid program, which is known as MO HealthNet, runs through the Missouri Department of Social Services.

Most Medicaid Enrollees Get Care Through Private Managed Care Plans

Over two-thirds of Medicaid beneficiaries are enrolled in private managed care plans that contract with states to provide comprehensive services, and others receive their care in the fee-for-service system.

Managed-care plans are responsible for ensuring access to Medicaid services through their networks of providers and are at financial risk for their costs.

In the past, states limited managed care to children and families, but they are increasingly expanding managed care to individuals with complex needs.

Close to half the states now cover long-term services and support through risk-based managed care arrangements.

Most states are engaged in a variety of delivery systems and payment reforms to control costs and improve quality including implementation of patient-centered medical homes, better integration of physical and behavioral health care, and development of value-based purchasing approaches that tie Medicaid provider payments to health outcomes and other performance metrics.

Community health centers are a key source of primary care, and safety-net hospitals, including public hospitals and academic medical centers, provide a lot of emergency and inpatient hospital care for Medicaid enrollees.

In FY 2016, HCBS represented 57 percent of total Medicaid expenditures on LTSS while institutional LTSS represented 43 percent.

This is a dramatic shift from 1995 when institutional settings accounted for 82 percent of national Medicaid LTSS expenditures.

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What Are The Eligibility Requirements For Medicaid In Missouri

The MO HealthNet program covers individuals who meet certain income and resource criteria including:

â Low-income families

â The elderly

â Blind/visually impaired individuals

â Disabled individuals

â Pregnant women

â Newborns and infants

â Uninsured women under the age of 65

The income criteria for eligibility is determined by poverty guidelines set forth by the federal government. Resource criteria typically apply only to the elderly, disabled, and blind individuals. For these applicants, resources such as savings and countable assets can impact eligibility for the program.

Blind and disabled individuals can qualify for Medicaid due to a âphysical or mental impairment, disease, or lossâ that prevents them from working at a job within their skill level for 1 year or longer. Anyone who qualifies for assistance through the federal Supplemental Security Income program is automatically considered eligible for the MO HealthNet program on the basis of disability.

How Much Does Medicaid Cost In Missouri

Apply for Medicaid St Louis MO Jones Elder Law

Most Medicaid plans in Missouri are free. However, some plans such as the plans for seniors and disabled people provide health coverage to people who dont meet the minimum income requirements once their spend down limit for the month is met. Also, the premium SCHIP plans for children have a monthly premium, which is determined based on your familys monthly income.

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How To Apply For Medicaid In Missouri

Apply for Medicaid online by visiting the Missouri Department of Social Services’ website or apply in person at your nearest Department of Social Services office. While you cant apply for Medicaid over the phone, you can call the Missouri Department of Social Services at 1-573-751-3221 to check the status of your application.

Section : Who Is Eligible To Apply For Medicaid In Missouri

Eligibility for the MO HealthNet program is based on several factors including income and resource criteria. Disabled, blind, and elderly individuals who meet the income and resource requirements may qualify as well as pregnant women and children. Indeed, children make up the majority of Medicaid recipients in the state of Missouri at this time.

Low-income women who are pregnant or who have recently given birth may qualify for Medicaid. Parents, guardians, and caregivers in low-income families may also be eligible. The goal of the program is to make sure that low-income individuals are able to find good health, treat illness, avoid premature death, and correct, rehabilitate, or limit a disability.

To qualify for the MO HealthNet program, applicants must be U.S. citizens, permanent residents, legal, aliens or nationals and a resident of Missouri who is in need of health care and insurance assistance. Your financial situation must be considered âlow-incomeâ or âvery low-incomeâ according to certain federal and state guidelines. And you must also be disabled , blind, elderly , pregnant, or be a parent or relative caregiver of dependent children who are under the age of 19 years.

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