Medical Services - MO HealthNet for Families, Kids, Pregnant Women and Newborns
MO HealthNet provides healthcare coverage to persons eligible for MO HealthNet for Kids, MO HealthNet for pregnant women and newborns, MO HealthNet for Families (MHF), Transitional MO HealthNet (TMH).
The purpose of the MO HealthNet program is to provide medical services to persons who meet certain eligibility requirements as determined by Family Support Division (FSD). The goals of the MO HealthNet program are to promote good health, to prevent illness and premature death, to correct or limit disability, to treat illness, and to provide rehabilitation to persons with disabilities. Eligible persons receive a "MO HealthNet Identification Card" and a notification of approval from the local FSD office.
The Family Support Division (FSD) determines a person’s eligibility for the MO HealthNet healthcare coverage. The MO HealthNet Division administers the MO HealthNet programs including establishment of benefit coverage, rates, claims processing, and all other aspects of daily operations.
Medical Care Services Provided
(each service is subject to certain limitations)
Covered services for participants of MO HealthNet for Kids, MO HealthNet for pregnant women and newborns, and MHF are the same as for MO HealthNet participants.
Health screenings, medical exams, immunizations, and other medically necessary treatment are among the covered services. Examples of covered services include:
- primary, acute and preventive care;
- inpatient hospital care;
- outpatient hospital services, including diagnostic services rendered through a hospital outpatient department or clinic;
- laboratory and x-ray services when prescribed by a physician, and provided by either physicians, clinics, x-ray facilities, or laboratories;
- physical, occupational and speech therapy **;
- dental, hearing and vision care **;
- home and community-based services such as nursing and personal care **;
- medical equipment and supplies;
- non-emergency medical transportation *;
- pharmacy; and
- mental health services such as outpatient counseling and inpatient psychiatric treatment **.
* Not available to children in higher income families receiving MO HealthNet for Kids.
** Services are limited for adults age 21 and over.
For more information on these services, see About the MO HealthNet Division. (published by the MO HealthNet Division)
If an eligible person has other medical insurance, that insurance company must be billed before MO HealthNet is billed with some exceptions.
Obtaining Needed Medical Services
Some persons receive MO HealthNet benefits through a "fee-for-service" arrangement, while others receive benefits through a MO HealthNet managed health care plan.
Persons receiving MO HealthNet healthcare coverage on a fee-for-service basis have freedom to choose any Missouri MO HealthNet enrolled provider when obtaining services. Otherwise, the person receiving the services must bear the responsibility for medical expenses incurred. MO HealthNet healthcare coverage pays the providers of services and does not make direct payments to persons for their medical expenses. (There may be some restrictions placed on person’s freedom of provider choice if it appears that there may be abuse or unjustified use of services.)
Persons receiving MO HealthNet through MO HealthNet managed care must obtain all needed services through an enrolled health care plan in their area of the state. MO HealthNet pays a capitation fee for each individual enrolled in a MO HealthNet managed care program. Some services are carved out and remain covered through fee for service.