The MO HealthNet for Families (MHF) program provides Healthcare coverage to low income MAGI households with children (age 0-18) who meet the eligibility guidelines.
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.
Effective August 28, 2007 Senate Bill 577 (2007) changed the name of Missouri Medicaid to MO HealthNet.
Effective January 1, 2014, the Patient Protection and Affordable Care Act (PPACA or more commonly called the ACA) of 2010 requires Family MO HealthNet programs to use Modified Adjusted Gross Income (MAGI) methodology.
All eligibility requirements in section 1805.000.00 Eligibility and Verification must be met in addition to the following:
NOTE: A parent or caretaker relative receiving Supplemental Security Income (SSI) is not eligible to receive MO HealthNet for Families (42 CFR 435.603(j)(1)). A parent receiving SSI should be included in the household but not receive MO HealthNet for Families benefits.
Countable family income for household size cannot exceed the MAGI equivalent standard based on the July 16, 1996 AFDC (current Temporary Assistance) income limits. These income limits are found in Appendix A.
To determine what household income should be used for eligibility, refer to the following manual sections:
Household composition rules follow federal tax-filing rules and are found at 1805.030.10 MAGI Household Composition.
42 CFR 435.4 defines a parent or caretaker relative as a relative of a dependent child by blood, adoption, or marriage with whom the child is living, who assumes primary responsibility for the child's care, and who is one of the following:
Only a parent or caretaker relative as defined above may receive MHF benefits.
The custodial parent/caretaker relative may claim the child as a dependent on income taxes, but is not required to.
When a child reaches age 18 he/she may continue to receive MHF if:
If a child reaches age 18 and is NOT attending secondary school:
If a child reaches age 18 and is NOT attending secondary school:
Student status is verified by self-attestation unless questionable. If the student status is questionable, the School Verification Report (IM-10) may be used. A school official should complete and sign the IM-10.
If eligible, begin date for MHF coverage is the first day of the month of application.
The end date is the day after an Adverse Action Notice (IM-80) expires.
Eligibility Guidelines for Prior Quarter are shown in MAGI manual section 1830.000.00 MO HEALTHNET FOR KIDS (MHK) - NON-CHIP COVERAGE. Income eligibility for MHF, which must be met in each individual PQ month, is shown on Appendix A.
When a household becomes ineligible for MHF due to new or increased earned income, they may remain eligible for coverage under Transitional MO HealthNet (TMH). Refer to manual section 1820.000.00 Transitional MO HealthNet for more information.
All households approved for MHF receive full MO HealthNet coverage. Coverage in all Missouri counties is now provided through a Managed Care plan. More information on covered services can be found on the MO HealthNet Division Participant Eligibility website.