Medical Services -MO HealthNet

MO HealthNet coverage is automatically available to all recipients of MO HealthNet, Nursing Care, Home and Community-based Services, Supplemental Aid to the Blind, Blind Pension, and Adult Supplemental Payments.

The purpose of the MO HealthNet program is to provide medical services to persons who meet certain eligibility requirements as determined by 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" or a letter from the Family Support Division.

The Family Support Division (FSD) determines client eligibility for the MO HealthNet program: the MO HealthNet Division administers the MO HealthNet program 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)

** Services are limited for adults who are not in a category of assistance for pregnant women or the blind.

MHD pays only the deductibles and co-insurance when any of the above items are covered by Title XVIII (Medicare) of the Social Security Act. MHD also pays the monthly premium for Medicare supplementary medical insurance for eligible assistance recipients age 65 or older and for certain blind or disabled persons. If an eligible person has other medical insurance, that insurance company must be billed before Medicaid is billed.

Obtaining Needed Medical Services

Some persons receive MO HealthNet benefits through a "fee for service" arrangement, while others receive benefits through a managed care plan.

Persons receiving MO HealthNet through fee for service have freedom to choose any vendor of needed services except that the chosen provider must be enrolled to participate in the MO HealthNet vendor plan in order for benefits to be used. Otherwise, the person receiving the services must bear the responsibility for medical expenses incurred. MO HealthNet pays only providers of services and does not make direct payments to person for their medical expenses. (There may be some restrictions placed on a person’s freedom of provider choice if it appears that there may be abuse or unjustified use of services.)

Persons receiving MO HealthNet through managed care must obtain all needed services through a health plan, physician sponsor, or other designated single source of total health care. MO HealthNet pays a capitation fee for each individual enrolled in a managed care program.