In accordance with 13 CSR 65-2 and 42 CFR 455.460, the MO HealthNet Division (MHD) collects a $750.00 application fee from all new and revalidating institutional providers. This requirement applies to organizational and institutional entities; individual practitioners, such as physicians and dentists, are not required to pay the application fee.
Institutional providers who have paid an application fee to Medicare or another state Medicaid agency within two (2) years of their MO HealthNet application date are exempt from paying the fee. Proof of this prior payment must be included with your application before MHD can begin processing.
For all other applicants, payments can be made electronically by credit card, debit card, or e-check using our contracted vendor, Global Payments/Collector Solutions (subject to a small convenience fee).
When applicable, providers should include the electronic receipt with their application. Alternatively, providers may submit a cashier's check or money order payable to DSS-MMAC Application Fee. Cash and personal or business checks will not be accepted.
Providers may mail their payment to:
Missouri Department of Social Services
MHD Provider Enrollment
(New Address)
Centers for Medicare & Medicaid Hardship Waiver Request
Providers may request an application fee hardship waiver from the Centers for Medicare & Medicaid Services (CMS).
Payment Requirement & Submission Rules
- Upfront Payment: The fee must be paid in full before MHD will process the enrollment application. If CMS approves the waiver, MHD will refund the fee.
- Combined Submission: A written request letter and supporting evidence must be submitted with the enrollment application. Separate requests will not be considered, will be returned, and notification sent to the provider via letter, email, or telephone.
Documentation & Justification
Simple assertions of financial strain are insufficient; providers must build a compelling, evidence-backed case. Neither MHD nor CMS are required to request missing files—providers bear sole responsibility for submitting complete evidence initially.
Evidence may include:
- Financial Proof: Comprehensive records such as historical cost reports, recent financial statements (balance sheets, income statements, cash flow statements), tax returns, etc.
- Supporting Factors:
- Considerable bad debt expenses
- Significant charity care or financial assistance offered to patients
- Substantive partnerships serving low-income populations
- Substantial funding through Disproportionate Share Hospital (DSH) payments
- Enrollment within a Presidentially-declared disaster area (under the Stafford Act)
Review & Appeals Process
Once submitted, MHD forwards the complete hardship request to CMS for evaluation. CMS will then issue a formal decision letter directly to both the provider and MHD. If the request is denied, the provider may appeal by submitting a written reconsideration request to CMS within 60 calendar days of receiving the determination notice. This appeal must be signed by the provider, a legal representative, or an authorized official, following the specific appeal instructions provided in the CMS denial letter.