The UWHS program provides women's health services for uninsured women:
NOTE: Women who have been sterilized are not in need of family planning services and are ineligible for the UWHS program.
UWHS coverage is not time limited and is subject to the standard MO HealthNet review and ex-parte processes. The only healthcare services covered by MO HealthNet for UWHS are family planning and family planning related services.
Senate Bill 577 (2007) added Section 208.659 to the Revised Statutes of Missouri authorizing a revision to 13 CSR 70-4.090, thereby establishing the Uninsured Women's Health Services program. The Centers for Medicare and Medicaid Services (CMS) approved an amendment to Missouri's Section 1115 Waiver, authorizing the revision in December 2008.
Through the UWHS program, Missouri provides women's health services to uninsured women who are in need of family planning services, from age 18 up to but not including age 56, with a family income less than or equal to 185% of the federal poverty level.
Effective January 1, 2014, the Patient Protection and Affordable Care Act (PPACA) of 2010 requires Family MO HealthNet programs to use Modified Adjusted Gross Income (MAGI) methodology. To reflect the PPACA requirement to remove income disregards from all Family MO HealthNet programs, the Federal Poverty Level (FPL) is increased. UWHS FPL increases from 185% to 201% on January 1, 2014. The PPACA removed net worth as an eligibility requirement.
Services:
NOTE: MO HealthNet for Families (MHF) eligibility factors for the criteria listed above apply, unless otherwise noted. MHF eligibility factors not listed above (such as Assignment of Support Rights, Cooperation in Obtaining Support, etc.) do not apply to the Uninsured Women’s Health Services program.
A woman must be age 18 and up to but not including age 56 to be eligible.
This factor of eligibility applies to the female applicant. It does not apply to other persons who may be included in the household (i.e. spouse of woman, dependent children). Follow the instructions outlined in Section 1805.010.05 for this eligibility factor.
While obtaining a social security number is not a factor of eligibility for other persons in the household, request the social security number, as it may be needed to verify income.
This eligibility factor is the same as for MHF. Refer to Section 1805.005.00.
This eligibility factor is the same as for MHF. Refer to Section 1805.010.10.
All MHF MAGI methodologies apply to UWHS.
A woman is eligible for UWHS coverage if the household’s MAGI does not exceed 201% of the federal poverty level (FPL) for the household size.
This eligibility factor is the same as for MHF. Refer to Section 1805.012.00
To be eligible for UWHS, a woman must be uninsured. Uninsured women are defined as women age eighteen (18) up to fifty-six (56) years of age without health insurance that covers family planning services. Refer to Section 1820.020.05.10 for definition of health insurance. A woman covered by health insurance that covers family planning services at the time UWHS eligibility is determined is ineligible, unless the insurance enrollment is already paid for by HIPP. There is no penalty for dropping insurance.
NOTE: Persons receiving Medicare are considered insured.
A woman that is insured simply because the Health Insurance Premium Payment (HIPP) program is paying the premium will be treated as though she is uninsured.
This definition is the same as for MO HealthNet for Kids. Refer to Section 1820.020.05.10.
In addition to being uninsured, the woman cannot have access to employer-sponsored health insurance (either through her employer or her spouse's employer) that covers family planning services. If the woman declares the available insurance does not cover family planning services, this must be verified by a copy of the insurance plan benefits or other valid plan documents. Access to insurance available through employment includes group memberships or private company insurance enrollment options offered by the employer. Examples of group memberships that could offer health insurance are a union, professional organization, or trade association.
If the woman or her spouse fails to purchase the health insurance, she is ineligible as long as it is available. It is considered available even though there is a limited open enrollment period for which they need to wait.
A woman is ineligible for UWHS if she qualifies for any other MO HealthNet program. Explore eligibility for any Family Healthcare program (MO HealthNet for Families, MO HealthNet for Kids, and MO HealthNet for Pregnant Women) prior to exploring eligibility for UWHS. If the participant has an active MO HealthNet for Families (MHF) or MO HealthNet for Kids (MHK) case, explore eligibility for MO HealthNet for Families prior to exploring eligibility for UWHS by completing an add-a-person application.
If ineligible for MO HealthNet for Families or any other full coverage program, explore eligibility for UWHS by registering a UWHS application and approve for UWHS if eligible on all UWHS eligibility factors. If the woman applies using the IM-SSL application, she is ineligible for MO HealthNet for the Aged, Blind, and Disabled (MHABD) unless she either indicates that she is disabled or receives Social Security disability or SSI benefits.
EXAMPLE: Ms. Johnson meets all eligibility requirements for UWHS, but is receiving Extended Women's Health Services (EWHS). Ms. Johnson is not eligible for UWHS as she is currently receiving MO HealthNet benefits under another program.
NOTE: Ms. Johnson should be reviewed for UWHS eligibility prior to closing EWHS.
EXAMPLE: Ms. Smitt receives Social Security Disability of $650.00 per month, has resources under $1,000 and does not receive Medicare. She meets all other eligibility requirements for UWHS, but as she is disabled, she qualifies for MO HealthNet for the Aged, Blind and Disabled (MHABD) based on disability. Ms. Smitt is not eligible for UWHS as she qualifies for MHABD.
EXAMPLE: Ms. Warren receives Social Security Disability of $1,000 per month, has resources under $1,000 and does not receive Medicare. She meets all other eligibility requirements for UWHS, but as she is disabled, she qualifies for MO HealthNet for the Aged, Blind and Disabled (MHABD) based on disability. Ms. Warren is not eligible for UWHS as she qualifies for MHABD on a spenddown basis. If Ms. Warren fails to purchase the spenddown coverage, she is ineligible as long as it is available. It is considered available even though she may not choose to pay her premium.
EXAMPLE: Ms. Harmony is included on her children's MO HealthNet for Kids case. Ms. Harmony submits an IM-1SSLapplication. Ms. Harmony is not pregnant, disabled, or blind. The eligibility specialist registers an add-a-person application for Family MO HealthNet and an application for UWHS. If Ms. Harmony is determined ineligible for MO HealthNet for Families, explore eligibility for UWHS.
UWHS coverage begins the first day of the month of application provided all eligibility factors are met. UWHS does not include prior quarter coverage.
Women in the Uninsured Women's Health Services program in need of family planning services are eligible for the same services as women in the Extended Women's Health Services (EWHS) program. These services are:
NOTE: Only women who are in need of family planning services can receive coverage for these services. Women who are sterilized are not eligible for UWHS.
There is no cost sharing for UWHS coverage. Services are provided through fee-for-service through approved MO HealthNet providers in all areas of the state.
The MO HealthNet Division (MHD) provides guidance to MO HealthNet providers of services covered by the various MO HealthNet eligibility codes (ME) codes. Refer to the benefit matrix located under "Covered Services" on the About the MO HealthNet Division webpage for listing of covered services. When responding to inquiries and at application for the UWHS program, explain the benefits and services available.
UWHS coverage is date-specific for participants at the time of closing.
Process UWHS applications without undue delay unless unusual or extreme circumstances exist. Complete the eligibility determination to ensure an applicant is mailed her notice of approval or denial within a period not to exceed 30 days.
Complete a review of UWHS eligibility every 12 months. This requirement is the same as for MHF. Refer to Section 0905.025.01.
When a UWHS review form (IM-1U) is received within 90 days that the case closed due to failure to complete and return a review form, take appropriate action to reopen the case and process the review using current procedures.
Prior to discontinuing a participant's coverage under UWHS, review the participant's possible eligibility under all MO HealthNet programs. Follow steps for an ex-parte review in MHF manual Sections 0905.025.16.05 - 0905.025.16.20.
EXAMPLE: Ms. Elrod reports that she is now insured and pregnant. Explore eligibility under MO HealthNet for Pregnant Women (MPW) prior to closing UWHS.
When closing an age-eligible woman in any MHF/MHK/MHABD program, include reviewing eligibility for UWHS in the ex-parte process if the participant is no longer eligible for any other MO HealthNet program. When a participant is determined ineligible for any MO HealthNet Program and the participant is female and between the ages of 18-56, register an Uninsured Women's Health Services (UWHS) application.