Your Clients Newly Eligible For Medicaid? Here’s What You Need To Know

After a lengthy legislative and legal battle, around 230,000 additional Missourians are now eligible for the state's Medicaid program, Mo HealthNet.

The state has apparently done almost nothing to advertise the program's expansion, except for posting a court-ordered notice on the Mo HealthNet website. According to KBIA radio, the Family Support Division of the state Department of Social Service has already received more than 4,000 applications.

These applications are presumed to be just sitting there, as an Aug. 11 video meant for staff shows Kim Evans, director of the Family Support Division, saying that while people can start applying now, staff would not be allowed to finalize any applications until Oct. 1 because of computer system upgrades.

Attorneys have sent a letter to state officials stating that waiting until October violates federal law.

So while the ongoing Medicaid saga continues, here's everything Missouri residents need to know about applying for coverage.

Who is eligible under the new rules?

Adults between the ages of 19 and 64 who earn up to $17,774 a year, or $36,570 for a family of four. Things like owning a house or car do not factor into eligibility.

"Expanding Medicaid will provide health insurance coverage to 230,000 Missourians who are now caught in a coverage gap – they earn too much to qualify for the current Medicaid program but not enough to afford private insurance," the Missouri Foundation for Missouri wrote.

What does Medicaid cover?

Medicaid covers costs of most medical services like going to the doctor for illness, immunizations, check-ups, while also covering costs of medications and hospital visits. MO HealthNet healthcare coverage pays the providers of services and does not make direct payments to patients. Patients may be required to pay a copay for services, ranging in amount from $0.50 to $10.

How does someone apply for coverage?

Missouri residents who qualify can visit mydss.mo.gov to apply. They can also call 855-373-9994 or download a paper application. If filling out a paper application, residents may mail it to 615 E. 13th St. Kansas City, MO 64106. Of fax it to 573-526-9400.

For additional information and questions, residents can call the Cover Missouri hotline at 1-800-466-3213.

Missouri's path to Medicaid expansion

Prior to expansion, Missouri had one of the most restrictive Medicaid eligibility levels for parents and childless adults in the nation, according to the Missouri Budget Project. As it stood, the program provided coverage for low-wage parents earning no more than $388 per month for a family of three, the lowest level allowed under federal law and the third-lowest eligibility level in the nation.

In August 2020, 53.25% of Missouri residents who voted were in favor of a constitutional amendment in Missouri to implement Medicaid expansion. The new eligibility was slated to take effect July 1.

But the long road to implementation began in April, when House Republicans resisted the will of the voters by removing $1.9 billion allocated for the program's July expansion when crafting the 2022 state budget.

The Senate then also voted against funding the program expansion.

Six days after the General Assembly presented Parson with the 2022 budget sans the expansion funding,the governor withdrew the state from its plan to expand Medicaid coverage altogether.

Protests across the state were held following the announcement. Shortly after, proponents took the matter to court.

Meanwhile, Parson warned that if the legislature did not reauthorize the medical provider tax, he could be forced to take a knife to the 2021-22 budget to fund the state's Medicaid program.

The Medicaid provider tax is collected from hospitals, nursing homes and pharmacies and generates $1.6 billion annually. Missouri is then eligible to receive an additional $3 billion in federal funds.

The legislature did not pass the reauthorization of that tax, as several GOP members wanted to include language in the bill that bans Medicaid coverage of certain birth control methods and blocks government funding of Planned Parenthood. Parson called the special session, and the tax bill was then passed without the amendments regarding birth control and abortion.

Cole County Circuit Judge Jon Beetem struck down the lawsuit filed by advocates seeking to expand Medicaid, but the Missouri Supreme Court in July issued a unanimous ruling reversing that decision.

The case was handed back to Beetem, who in mid-August ruled the Missouri Department of Social Services must allow newly eligible residents that qualify for benefits under voter-approved Medicaid expansion to enroll and cannot impose greater restrictions on them.

In his ruling, Beetem rejected the state's request that it be allowed to make its case for why it needs two more months to begin accepting newly eligible residents.

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