Missouri Department of Social Services
221 West High Street • P.O. Box 1527 •
Jefferson City, MO 65102-1527
The qualifications for the MO HealthNet Managed Care program are based on a combination of factors, including family composition, income level, insurance status, or pregnancy status depending on the eligibility group in question. The MO HealthNet Managed Care population consists of different eligibility groups that have been combined into three categories for the purpose of rate setting. The MO HealthNet Managed Care population must enroll in a MO HealthNet Managed Care health plan. Those that receive Supplemental Security Income (SSI), meet the medical definition for SSI, or are eligible for adoption subsidy benefits may choose not to enroll or voluntarily disenroll from the MO HealthNet Managed Care Program at anytime
The three categories are Category of Aid (COA) 1, COA 4, and COA 5. (COA 2 and 3 are not in use).
Eligibility Criteria for all categories
| Category of Aid 1 | ME Codes | ME Code Description |
|---|---|---|
| MO HealthNet For Families | 05 | Caretaker (MHF-AD) |
| 06 | MHF Dependent (MHF-CD) | |
| MO HealthNet for Families for Poverty Level Children | 40 | MO HealthNet Poverty Children |
| 62 | MO HealthNet Poverty Children - Health Initiative Fund | |
| Newborns | 60 | Newborns (Eligibility only) |
| MO HealthNet for Refugees | 10 | Vietnamese or Other Refugee |
| 19 | Cuban Refugee | |
| 21 | Haitian Refugee | |
| 24 | Russian Jew Refugee | |
| 26 | Ethiopian Refugee | |
| MO HealthNet for Pregnant Women | 18 | Pregnant Women - MPW |
| 43 | Preg Women-60 days Postpartum - MPW | |
| 44 | Preg Women-60 days Poverty | |
| 45 | Preg Women-Poverty | |
| 61 | Preg Women Poverty 133% -185% FPL-HIF |
| Category of Aid 4 | ME Codes | ME Code Description |
|---|---|---|
| DSS Children's Division | 07 | Foster Care - IV - E |
| 37 | Title XIX-FFP/HDN | |
| 08 | CWS-FC | |
| 65 | Group Home - HIF | |
| 66 | Child Welfare - HIF | |
| Adoption Subsidy | 56 | Adoption Subsidy- IV - E Eligible |
| 36 | Adoption Subsidy-FFP | |
| 57 | Adoption Subsidy - CWS | |
| DSS Division of Youth Services | 29 | Div of Youth Svcs FYS-FC |
| 52 | DYS-GR | |
| 50 | DYS-Poverty | |
| 68 | DYS - HIF | |
| Juvenile Court | 30 | JC - FC |
| 64 | JC - Group Home - HIF | |
| 69 | JC - HIF | |
| 70 | JC - Poverty |
| Category of Aid 5 | ME Codes | ME Code Description |
|---|---|---|
| 71 | CHIP 134-150% Age 1-5 (No Cost) | |
| 72 | CHIP 101-150% Age 6-18 (No Cost) | |
| 73 | CHIP 151-185% Age 1-18 (Premium) | |
| 74 | CHIP 186-225% Age 0-18 (Premium) | |
| 75 | CHIP 226-300% Age 0-18 (Premium) |
09/01/07