Eligibility and Spend Down Training
Presented by Amanda Fahrendorf, MHD Education & Training
Last Revised: December 2025
Overview
- Managed Care
- MO HealthNet Benefits
- Education and Training
- Eligibility Examples
- Spend Down
- Resources
- MO HealthNet Coverage
MO HealthNet Coverage
Missouri's Medicaid program is called MO HealthNet. MO HealthNet covers qualified medical expenses for individuals who meet certain eligibility requirements.Depending on the type of coverage they qualify for, participants will get their services through the MO HealthNet Fee-For-Service (FFS) Program or the MO HealthNet Managed Care Program.MO HealthNet offers healthcare coverage through both of these programs. Which program a participant receives their services through depends on their age and eligibility.Managed Care
- Parent or guardian with child under age 19 in the home
- Child (birth through age 18)
- Adult (age 19-64) without a disability
- Pregnant woman including her newborn child
Fee-For-Service
- Person with a disability
- Senior (age 65 and older)
- Blind or visually impaired adult
- Woman (under age 65) with breast or cervical cancer
- Managed Care
Managed Care
- Participants enrolled in a MO HealthNet Managed Care Health Plan receive their services through the health plan's provider network. The health plan network may include providers not enrolled in the FFS Program.
- Listed below are the MO HealthNet Managed Care Health Plans. Each health plan provides services in every county in Missouri.
- All MO HealthNet Managed Care Health Plans provide the same base array of services.
Contact Information for Managed Care Health Plans
Home State Health
- 855-694-HOME (4663), Option 3
- Message Home State Health
- Provider website
- Join the Home State Health network
Show Me Healthy Kids
- 877-236-1020, Option 4
- Message Show Me Healthy Kids
- Provider website
- Join the Show Me Healthy Kids Network
Healthy Blue
Managed Care Provider Communications
If providers are unable to resolve a Managed Care issue directly with a health plan, contact a Managed Care Liaison by completing a Managed Care Provider Request for Information.
- MO HealthNet Benefits
Participants should visit Benefits & Services to review the Managed Care and FFS Guides. Participants may also compare the Managed Care Health Plan benefits by viewing Compare Health Plans.
- eMOMED Path to MO HealthNet Resources
The MO HealthNet Provider Information page is your hub for Medicaid information and resources.
This page can be found on the MHD website or in eMOMED.
In eMOMED, select Provider Information under the External Links header.
- Provider Information
The Provider Information page offers a wealth of resources, including the Education and Training page.
- Education and Training
The Education & Training page offers providers a quarterly interactive calendar and a Printable Training Calendar for providers to register for 2-hour interactive program specific webinars that cover:
- Navigating Provider Resources
- eMOMED Overview
- Eligibility and Spend Down
- Education and Training
The Provider Training Calendar also includes trainings offered by the Managed Care health plans and upcoming in-person workshops hosted by MHD, held in Jefferson City.
Explore the Education & Training page for additional trainings and resources.
For more program specific resources visit the Program Specific Pages.
- Provider Overview Guide
The MO HealthNet Provider Overview Guide assists providers with:
- Navigating MO HealthNet resources
- Provider Manuals
- Claims & Billing
- Fee Schedules & Rates List
- Forms
- Eligibility
- Spend Down Program
- eMOMED
- And much more!
- Benefit Tables
Benefit Tables advise if a participant is eligible for a service based on their Medicaid Eligibility (ME) Code. This table can be found on the Education & Training page.
Providers can use this in combination with the program specific Provider Manual to know what services are covered for Medicaid participants.
- Benefit Tables
Providers may also review the Master List of Covered Services for a quick glance at all program benefits & limitations.
- Medicaid Eligibility Codes
Medicaid Eligibility Codes can also be found on the Education & Training page.
This resource lists Medicaid Eligibility (ME) codes and their descriptions.
- Contact Us
Select Contact Us located on the Education & Training page for a list of MO HealthNet provider resources and contact information.
To receive MO HealthNet updates and our quarterly Newsletter, subscribe to MO HealthNet News.
- Checking Eligibility
Once the provider determines the participant has or may have MO HealthNet coverage it is the provider’s responsibility to check the participant’s eligibility. Eligibility is updated daily so this must be done before every visit. The participant must be eligible on the date of service.
The below information should be reviewed:
- Name on file
- Eligibility on date of service
- Medical eligibility/plan code
- Medicare
- Commercial Insurance
- MO HealthNet Managed Care enrollment
- Administrative Lock-In
- Checking Eligibility
Providers can check eligibility in two ways:
- Online in eMOMED: Quick and easy! You will log into eMOMED with your User ID and password to check real time eligibility.
- Contact Provider Communications: Call (573) 751-2896, Option 1. This an Interactive Voice Response (IVR) system that can address participant eligibility, last two check amounts, claim status inquiries, provider enrollment status, annual review date and more.
- eMOMED
Quick and easy!
To register for eMOMED (https://www.emomed.com/), click ‘Register Now.’
Everyone accessing eMOMED will need to set up their own User ID and password.
For questions about registering, contact the eMOMED Help Desk at 573-635-3559, Option 1.
- Eligibility in eMOMED
Eligibility is Date of Service (DOS) specific. Providers should request eligibility for current or past dates, rather than a date span. Span dates are helpful when trying to determine when/if a participant met their spend down during the month.
Enter the NPI and the date of the visit. The date cannot be more than one year old, and it can not be in a future calendar month.
If known, enter the participant’s DCN and click Search.
