The Medical Assistance for Families (MAF) program provides MC+ Healthcare coverage to low income families with children.

0905.005.00 LEGAL BASIS (MAF)

IM-46 May 13, 2005 IM-54 June 03, 2004 , IM-65 June 4, 2002, IM-218 December 13, 2001

The Personal Responsibility and Work Opportunity Act (PRWORA) of 1996 established a new Medicaid eligibility group for low-income families with children under Section 1931 of the Social Security Act. In Missouri, this program is Medical Assistance for Families (MAF). Eligibility for this group is based on July 16, 1996 Aid to Families with Dependent Children (AFDC) requirements. In June 1999, Missouri began referring to the Medicaid program for all family eligibility groups as MC+.

Effective January 1, 2002 the Center for Medicare/Medicaid Services (CMS) approved Missouri's use of less restrictive income methodologies than those in effect July 16, 1996. These changes raised the need standard and the net income limit to 100% of the federal poverty level.

Effective July 1, 2002 Missouri House Bill 1111 (2002) lowered the need standard and the net income limit to 77% of the federal poverty level.

Effective July 1, 2004 Missouri House Bill 1011 (2004) lowered the need standard and the net income limit to 75% of the federal poverty level.

Effective July 1, 2005 Missouri House Bill 11 (2005) lowered the need standard and the net income limit to the July 16, 1996 AFDC income standards.


Claimants must meet the eligibility factors listed below. The eligibility requirements are the same as for the Temporary Assistance program except where stated.

  1. Social Security Number.
  2. Age of Child
  3. Relationship of caretaker to child
  4. Child living in the home of caretaker
  5. Residence
  6. Citizenship and Alien Status.
  7. Assignment of Medical Support.
  8. Cooperation in Pursuit of Medical Support.
  9. Need.

0905.010.05 Social Security Number (MAF)

IM-#51 April 26, 2002

Section 1902 (a) of the Social Security Act requires application for and divulgence of a SSN as a condition of eligibility for MAF. This requirement applies only to those persons for whom healthcare coverage is being requested or received. It does not apply to parents or children included in the assistance group for whom coverage has not been requested.

Obtain a copy of the Social Security card for all person for whom coverage is requested at the time of the initial application whenever possible. If a card is not available but the number is know, accept the applicant's statement and enter the Social Security number into the SUPD system. If the number is correct, it will be verified by the system. It is only necessary to obtain further verification if the system match returns an indicator other than “V”.

For persons requesting coverage who do not have a SSN, proof of application for the SSN must be obtained prior to the individual's approval. If the IBTH screen indicates a SSN was requested, further verification is not required.

Do not deny or delay approval pending issuance of an SSN once the application for the SSN has been completed.

Advise the family the social security numbers will be used to determine eligibility and verify information.

0905.010.05.05 Failure to Complete a SSN Application or Furnish a SSN

IM-#51 April 26, 2002

Individuals failing to complete an application for an SSN or failing to provide an existing SSN are not eligible for healthcare. Include their needs and income in the budget when determining eligibility for the remaining members.

When processing applications containing individuals who have not applied for an SSN or who have not provided an existing number, use the following procedures.

  1. At application, give the family a reasonable length of time (up to 15 days) to apply for the SSN or replacement card, entering this date on the SSN-1. If sending the claimant a request for information form, note the claimant must apply for the SSN on that form.
  2. If no response is received from SSA within two days following the date given on the SSN-1, inform the family that an SSN application needs to be completed.
  3. If SSA returns the SSN-1 indicating the SSN application was not completed, immediately inform the family the SSN application must be completed. Assist the family in any way possible to get this completed.
  4. For cases in which some assistance group members have complied, while others have not, by the 30th day following application, use the following procedures.
    1. Approve other members of the assistance group if eligible. The non-compliant individual(s) should be shown on the IMU5 as Sanctioned (“S” LOC) with reason of “N” in field 13g2.
    2. Notify the family of approval of specific individuals and denial of the non-complaint individual for failure to comply with the SSN requirements.
  5. If the non-compliant individual is the only eligible child or if all members of the assistance group do not comply, deny the application by the 30th day and notify the family. If there is no eligible child in the home, the caretakers do not qualify for MAF.

    Individuals denied due to failure to apply for, or disclose an existing SSN must verify they have complied before eligibility can be established. Their eligibility begins no earlier than the first day of the prior quarter preceding the date they comply. Determine cooperation on this factor at each reinvestigation.

0905.010.10 Age Of Child (MAF)

IM#34 April 20, 2015, IM-#81 September 10, 2013

Section 208.040 RSMo states that to be eligible for MAF, a child must be under the age of 19 years. Refer to Section 0205.020.00

RSMo 208.151.1 effective August 28, 2013, allows individuals under the age of 26 who had been in foster care on the day they turned 18 or the 30 days prior, who are rejected for or lose eligibility for MO HealthNet through the Family Support Division (FSD) to be eligible for healthcare coverage through the Children's Division.

Determine the applicant’s eligibility for MO HealthNet coverage through the FSD. If they are ineligible for FSD coverage, refer the former foster care individual to the Children's Division for coverage.

EXCEPTION: Uninsured Women’s Health Services (UWHS) or Extended Women’s Health Services (EWHS) do not provide full MO HealthNet benefits. When an applicant/participant is eligible for either of these programs, they must be referred for full healthcare coverage through the Children’s Division.

If the application for MO HealthNet coverage is rejected or approved for UWHS, it is the responsibility of the applicant to respond to a paragraph included on the MO HealthNet notice. The paragraph in the notices serves as the FSD referral to the Children’s Division. The notices direct individuals to contact the MO HealthNet open enrollment broker by telephone to 800-348-6627, or the Children's Division at http://dss.mo.gov/cd/ or by telephone to 573-522-8024.

If the applicant is eligible for coverage through FSD and they are currently receiving ME 38 coverage through Children’s Division do not reject the application. Send an email, with a subject line of AC ME 38 - NEEDS TO BE CLOSED to Cole.MHNPolicy@dss.mo.gov. Include the applicant’s name, DCN, and current address.

0905.010.15 Relationship Of Caretaker To Child (MAF)

Section 208.040 RSMo states MAF may be granted to children living with their father, mother, grandfather, grandmother, brother, sister, stepfather, stepmother, stepbrother, stepsister, uncle, aunt, first cousin, nephew or niece. Section 208.043 RSMo states MAF may also be granted when the child is living with a legal guardian. Regulation 40-2.060 provides further clarification for determining eligible relationships. Refer to Section 0205.025.00

0905.010.20 Child Living In The Home Of Caretaker (MAF)

According to Section 208.040 RSMo (1969), MAF benefits are available only for children living with a parent or other eligible caretaker in a place of residence maintained as his/her home. Refer to Section 0205.030.00 - 0205.030.10.05

0905.010.25 Residence (MAF)

Section 208.040 RSMo states to be eligible for MAF, the caretaker and children must be Missouri residents. Refer to Section 0205.035.00 - 0205.035.10