The MO HealthNet for Kids (MHK) program provides MO HealthNet to children under age 19. Children may be eligible if their Modified Adjusted Gross Income (MAGI) for household size is less than the appropriate Federal Poverty Level (FPL):
Children in households with income above the appropriate FPL could still be eligible for healthcare benefits under the CHIP program. Refer to section 1840.000.00 MO HEALTHNET CHILDREN'S HEALTH INSURANCE PROGRAM for eligibility requirements.
Section 208.151.1(12) RSMo beginning January 1, 1988, provides Title XIX coverage to a group of age-limited children with family income less than 100% of the federal poverty level.
SB 765 enacted changes effective July 1, 1990, providing Title XIX coverage to children under six years old with family income less than 133% of the federal poverty level and eliminating the resource factor of eligibility for Medicaid for Children programs.
The Omnibus Budget Reconciliation Act of 1990 (OBRA '90) and House Bill 447 mandate Medicaid coverage to children, age six and over, born after September 30, 1983, up to age 19, if their family's income is below 100% of the federal poverty level.
HB 564 enacted changes effective January 1, 1994, providing Title XIX coverage to children under one year old with family income less than 185% of the federal poverty level and eliminated the born after September 30, 1983 provision for coverage of children ages six through 18.
In June of 1999 Missouri began referring to the Medicaid program for all family eligibility groups as MC+.
Effective September 1, 2007, the Missouri Health Improvement act of 2007, Senate Bill 577 changed the name of Missouri Medicaid to MO HealthNet.
Effective January 1, 2014, the Patient Protection and Affordable Care Act (PPACA, also known as the ACA) of 2010, requires Family MO HealthNet programs to use Modified Adjusted Gross Income (MAGI) methodology. To reflect the ACA requirement to remove income disregards from all Family MO HealthNet programs, the Federal Poverty Level (FPL) is increased as follows:
Along with using MAGI methodology to determine income, the ACA removed net worth as a requirement.
All eligibility requirements in section 1805.000.00 Eligibility and Verification must be met in addition to the following:
The income maximums for Non-CHIP children are:
Determine household size and income eligibility for MO HealthNet non-CHIP by following Modified Adjusted Gross Income (MAGI) policy shown in IM Manual sections 1805.030.00 through 1805.030.25.15 Modified Adjusted Gross Income Methodology.
Refer to manual section 1830.020.00 Prior Quarter for budgeting income in the prior quarter.
For information regarding referral for medical support, see manual section 1805.040.00 Cooperation in Pursuit of Medical Support.
NOTE: Do not hold up approval for a completed Referral/Information for Child Support Services (CS-201). FSD can only sanction a person for non-cooperation with a request from Child Support.
Coverage begins with the first day of the month of application, if eligible. When a child is ineligible for the month of application, but eligible for the next month, begin coverage with the first day of the month in which eligibility is met.
Coverage ends on the date a MO HealthNet non-CHIP child's benefits are closed. This is a date specific closing.
NOTE: The individual DOES NOT have to be eligible in the month of application to be eligible for prior quarter benefits.
The effective dates of prior quarter benefits can be no earlier than the first day of the third month prior to the month of application.
To be eligible for prior quarter an individual must meet the criteria listed below for each month of prior quarter.
NOTE: Each Prior Quarter month has its own independent evidence for the following: Prior Quarter Income, Prior Quarter Deductions, and Prior Quarter Medical Bills.
The start date of the Prior Quarter specific evidence will be the first day of that individual month and the end date will be the last day of that individual month. All other evidence will be backdated by the system to the first day of the earliest Prior Quarter month.
Determine income for prior quarter months using the same methodology as the month of application. These guidelines are in manual section 1805.030.00 Modified Adjusted Gross Income (MAGI) Methodology.
When completing income budget(s) for prior quarter months, use reasonable compatibility (RC) to confirm the self-attestation of income in each month. Please refer to manual section 1808.030.15 Reasonable Compatibility for more information on RC.
Use electronic data sources when available to verify attested information. If evidence cannot be verified electronically or by existing case information, staff should attempt to contact the participant by phone prior to sending an IM-31A. Allow 10 days for the individual to provide the requested information.
EXAMPLE: Sue applied for benefits on her son, Austin, in July. She requested prior quarter coverage for April, May and June. Because Sue’s income statement was not reasonably compatible for May, and the Eligibility Specialist was not able to contact her by phone, an IM-31A was sent. Sue failed to provide the requested information within the 10 day IM-31A timeframe. All prior quarter months, April, May and June, were rejected for Failure to Cooperate. Since she provided all of the other necessary information, a determination can be made for application month and ongoing coverage.
The individual may apply or reapply for prior quarter for up to one year after the application date. If it is a reapplication, only request the unverified information from the previous application for prior quarter.
EXAMPLE: Sue returns in December and requests that prior quarter for her son be explored again for April, May and June. Sue is provided with the IM-31A and given 10 days to provide the outstanding income information from May that was previously requested and not provided.
Reasonable Opportunity is not allowed for prior quarter months. If citizenship is not provided at application and the individual goes into their 90 day Reasonable Opportunity period, reject prior quarter for citizenship. If the individual provides citizenship verification within the 90 day Reasonable Opportunity period, reopen the prior quarter application and run a determination if all the evidence has been verified.
Prior quarter for MO HealthNet for Pregnant Women (MPW) is treated differently. Review policy on prior quarter for MPW applications, 1850.030.00 PRIOR QUARTER (PQ) AND MONTH OF APPLICATION ELIGIBILITY.