- Welcome
Welcome to the MO HealthNet Managed Care Program! This guidebook will give you the basic information you need to manage your healthcare benefit. Please read this handbook carefully.
MO HealthNet is Missouri’s Medicaid program. You may be enrolled in Managed Care because you meet one or more of the following requirements:
- Pregnant woman including her newborn
- Child (birth to age 18)
- Parent with child in the home
- Adult (age 19 to 64) without a disability
If you are not in one of these groups or if you have Medicare, you will not be enrolled in Managed Care. You would get services through MO HealthNet Fee-For-Service program. For more information, review the Fee-For-Service Guide.
To see eligibility requirements for MO HealthNet, visit the MO HealthNet Application page.
To learn more about your healthcare coverage, visit MyMOHealthPortal.com.
Enrollment materials are available in alternative formats and communication modes.
Hay información en español. ¡Servicios interpretativos gratis! Llame al 800-348-6627 (TTY/TTD:711).
- How does Managed Care work?
The MO HealthNet Managed Care Health Plan pays providers directly for services such as office visits, tests, or procedures. Providers can be doctors, dentists and other healthcare professionals.
- What can I expect?
After you are approved for coverage, you will be assigned to a MO HealthNet Managed Care Health Plan. You will receive your healthcare identification cards. See Managed Care and MO HealthNet Identification Cards in the next section. You will also get a letter that gives you information on your new health plan and when services began.
You will continue to receive health care coverage through the Managed Care Program as long as you are eligible.
- What if I have other insurance?
If you have MO HealthNet and private insurance, your private insurance will be billed first for any claims, and MO HealthNet will be billed second. If you have a change and gain private insurance, or if you no longer have private insurance, you need to report the change in one of these ways:
- Report a change online at mydss.mo.gov
- Call the Managed Care Enrollment Helpline at 800-348-6627
- Call the Family Support Division at 855-373-4636
- Visit your local Family Support Division Resource Center
- Do I have to be in Managed Care?
You may choose to opt out of Managed Care if you meet one of the following:
- Eligible for Supplemental Security Income (SSI) benefits
- Children who are enrolled in the Special Health Care Needs program
- Disabled and 18 or younger
- Health Risk Assessment
The Health Risk Assessment form helps your health plan understand your health care needs.
You may complete this assessment online at MyMOHealthPortal.com by creating an account or signing in to your account.
You may also complete the PDF version of the Health Risk Assessment. The form is available in both English and Spanish.
You need to fill out the form for each person in your household and return it via email or mail.
- Managed Care and MO HealthNet Identification Cards
After you are approved for coverage, you will receive your MO HealthNet ID card and a Health Plan Member ID card in the mail. You must show both these ID cards each time you get services. If you do not show your card, you may be responsible for payment. Your MO HealthNet Managed Care Health Plan will also mail you a member packet that will include a member handbook.
Visit Request New Card for replacement cards and more information.
- Managed Care Health Plans
You were automatically enrolled into a MO HealthNet Managed Care Health Plan the day you were approved for MO HealthNet. You can have one health plan for the whole family, or you can have a different health plan for each family member. Each health plan offers the same services and benefits and has a network of doctors, hospitals, and other providers across the state of Missouri that you may see for care.
- Member Rights
As a MO HealthNet Managed Care health plan member, you have certain rights that protect the quality of care you receive from your health plan. You have the right to:
- Be treated with respect and dignity
- Receive needed medical services
- Privacy and confidentiality (including minors) subject to state and federal laws
- Select your own primary care provider
- Refuse treatment
- Receive information about your health care and treatment options
- Participate in decision-making about your health care
- Have access to your medical records and to request changes
- Have someone act on your behalf if you are unable to do so
- Be free of restraint or seclusion from a provider who wants to:
- Make you do something you should not do
- Punish you or get back at you
- Make things easier for them
- Be free to exercise these rights without retaliation
- Receive one copy of your medical records once a year at no cost
- Member Responsibilities
As a MO HealthNet Managed Care health plan member, you also have certain responsibilities:
- Report any important changes to the Family Support Division online at mydss.mo.gov or by calling 855-373-4636. Examples of important changes include:
- The birth of a baby
- A new dependent
- A change in your income
- A new address
- A new phone number
- Be knowledgeable about your medical coverage
- Get routine and ongoing care from your providers
- Contact your primary care provider first when needing care
- Only use the emergency room in an emergency
- Make and keep appointments, or call ahead to cancel
- Carry your current MO HealthNet ID Card and your MO HealthNet Managed Care health plan card at all times and present them at your appointments
- Report any important changes to the Family Support Division online at mydss.mo.gov or by calling 855-373-4636. Examples of important changes include:
- Do I have to pay a premium?
Based on your family’s income and family size, you may need to pay a monthly premium. The letter you get from the Family Support Division about your eligibility will tell you if you need to pay a premium. If you have any questions about premiums, call 877-888-2811.
You may not be required to pay a premium if your child is a member of a federally recognized American Indian or Native Alaskan tribe and you provide proof of membership.
To prove your child is a member, please send a copy of their tribal membership card or official letter issued by the tribe that is recognized by the United States Department of the Interior, Bureau of Indian Affairs by mail, fax, or email to:
MO HealthNet Division Constituent Services
PO Box 6500
Jefferson City, MO 65102
Fax: 573-526-2471
Email: Ask.MHD@dss.mo.govNOTE: Please use “Premium Payments” in the subject line of your email.
- Can I change my health plan?
You have the right to choose the health plan that best fits your health care needs. You can only change your health plan during certain times, including:
- Within 90 days of when your coverage begins
- During your annual open enrollment period
- When a Managed Care health plan changes
You can also request a new health plan anytime you have “just cause,” such as:
- A grievance or appeal
- You or your child’s provider is with a different health plan
- Your provider is culturally insensitive
- The enrollment broker or state agency makes a mistake during a previous assignment process
- If your family is on different plans and you want everyone on the same plan
- The state agency puts sanctions on a health plan for not following contract requirements
- Poor quality of care
- No covered health care services or providers in your area who are skilled in dealing with your health care needs
- The health plan does not cover services you or your child’s needs because of moral or religious reasons
- How do I change my health plan?
There are three ways you can change your health plan:
- Request a change online at MyMOHealthPortal.com
- Call 800-348-6627 (TTY: 711) Monday—Friday from 7 AM - 6 PM
- Mail your signed and completed health plan change form(s) and Health Risk Assessment in the pre-paid envelope provided to:
MO HealthNet Enrollment Center
PO Box 771082
St Louis, MO 63177-1082IMPORTANT: You will need to submit a change request form with each family member’s health plan choice.
- Choosing a Primary Care Provider
Your primary care provider is the doctor, nurse practitioner, or clinic you call when you need health care services, unless it is an emergency.
You must choose a primary care provider that is with the same health plan you are enrolled in. If you have a chronic illness, special needs, or are pregnant, your primary care provider may be a specialist. You can also choose a Federally Qualified Health Center (FQHC) as your primary care provider. FQHCs provide primary care and other core services such as: health care, preventive (wellness), behavioral health, immunizations (shots), home nurse visits, and other services.
You need to make sure your primary care provider accepts your Managed Care health plan. If they do not, you will need to either choose a new provider or change health plans.
If you still need to find a primary care provider, contact your health plan directly for help. If you do not choose a provider, the health plan will choose one for you.
- How do I change my primary care provider?
Your primary care provider is the doctor, nurse practitioner, or clinic you call when you need health care services, unless it is an emergency.
You must choose a primary care provider that is with the same health plan you are enrolled in. If you have a chronic illness, special needs, or are pregnant, your primary care provider may be a specialist. You can also choose a Federally Qualified Health Center (FQHC) as your primary care provider. FQHCs provide primary care and other core services such as: health care, preventive (wellness), behavioral health, immunizations (shots), home nurse visits, and other services.
You need to make sure your primary care provider accepts your Managed Care health plan. If they do not, you will need to either choose a new provider or change health plans.
If you still need to find a primary care provider, contact your health plan directly for help. If you do not choose a provider, the health plan will choose one for you.
- Annual Renewals
Each year you will be required to:
- Complete an annual renewal – Every year, you will have to complete an annual renewal to make sure you are still eligible for healthcare coverage. If your eligibility changes at any time, your coverage may end. Renewals must be complete within 90 days of notification. For more information, visit: mydss.mo.gov/renew
- Review your enrollment – You will get an annual open enrollment packet where you will have a chance to change your health plan if you want to. If you are happy with your current health plan, you do not have to change anything. If you do not change anything you will stay in your current health plan.
- Reporting Changes
If you have changes in your income, address, or phone number, or have a new baby, report them online at mydss.mo.gov or call the Family Support Division at 855-373-4636.
- Access to Care
Your health plan must make providers available close to where you live. The health plan must provide urgent care for physical or behavioral health illnesses within 24 hours, regular care if you have symptoms within five business days, and regular check-ups within 30 calendar days. There are special requirements for maternity care.
- Grievance or Appeal
To make a grievance or appeal, call or write to your MO HealthNet Managed Care health plan. Refer to the Contact Us section of this guide.
- Release for Moral or Religious Reasons
The health plan may not cover services you or your child needs because of moral or religious reasons. If this happens, your health plan will let you know how and where else to get the service.
- Sick Child
If your child gets sick, you should call your primary care provider first unless it is an emergency. If it is an emergency, call 911 or go to the nearest emergency room, even if it is not in your health plan network.
- Specialist
If you need a specialist, your primary care provider should refer you.
- Contact Us
If you have questions about your healthcare coverage or need more information, you can contact your Managed Care Health Plan or the MO HealthNet Division:
- Online: Visit MyMOHealthPortal.com to apply, check your status, or report a change.
- Email: Ask.MHD@dss.mo.gov
- Call: MO HealthNet Managed Care Enrollment Helpline at 800-348-6627.
- Please have your identification Number from your MO HealthNet card ready.
- The Helpline is open from 7:00 am to 6:00 pm, Monday through Friday (except holidays).
- MO HealthNet Managed Care Health Plans
Call if you need help finding a provider or if you have questions about your coverage or any unpaid medical bills.
- Hearing or Speech Impaired
If you are deaf, hard-of-hearing, deaf-blind, or have difficulty speaking, call Relay Missouri at 800-735-2466 (Voice) or 800-735-2966 (Text Phone).
- Interpreter Services
- English - ATTENTION: If you speak English, language assistance services, at no cost, are available to you. Call 800-348-6627.
- Spanish - ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 800-348-6627.
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- Arabic
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- Dutch - LET OP: Als u Nederlands spreekt,is gratis taalbegeleiding voor u beschikbaar.
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- (Farsi) Persian
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- Portuguese - ATENÇÃO: Se fala português, tem ao seu dispor serviços linguísticos gratuitos. Ligue para o número 800-348-6627.
- Amharic - ማሳሰቢያ፦ አማርኛ የሚናገሩ ከሆነ፣ የቋንቋ እገዛ ወይም የትርጁማን አገልግሎት በነፃ ያገኛሉ። ወደ
800-348-6627 ይደውሉ።
- English - ATTENTION: If you speak English, language assistance services, at no cost, are available to you. Call 800-348-6627.
- Missouri Medicaid (MO HealthNet)
Missouri Medicaid (MO HealthNet) Contacts Phone Number MO HealthNet Case Information 800-348-6627 Third Party Liability Unit 573-751-2005 MO HealthNet Division 573-751-6944 To apply for MO Medicaid 855-373-9994 - Family Support Division (FSD)
Family Support Division (FSD) Contacts Phone Number FSD Information Center 855-373-4636 Food Stamp/Temporary Assistance (TA) Case Information 800-392-1261 Food Stamp/TA Child Care Interviews 855-823-4908 Rehabilitation Services for the Blind 800-592-6004 Supplemental Aid to the Blind 866-877-8155 - Useful Contacts
Useful Contacts Phone Number Office of Child Advocate 866-457-2302 State Technical Assistance Team 800-487-1626 DSS Text Telephone 800-735-2966 DSS TTD Voice Access 800-735-2466 Translation Services 800-348-6627 Department of Mental Health 800-364-9687 Senior Medicare Patrol 888-515-6565 ParentLink WarmLine 800-522-8522 Division of Developmental Disabilities 800-207-9329 Department of Health & Senior Services 573-751-6400 Special Health Care Needs 573-751-6246 Missouri Care Options 866-835-3505 Tel-Link (Pregnant Women & Children) 800-835-5465 Division of Vocational Rehabilitation 877-222-8963 Community Leaders Assisting the Insured of Missouri 800-390-3330 Child Support Call Center 866-313-9960 - Report a Concern Contacts
Report a Concern Contacts Phone Number Child Abuse/Neglect Hotline 800-392-3738 Adult Abuse & Neglect Hotline 800-392-0210 MO School Violence Hotline 866-748-7047 Report Medicaid Fraud 573-751-3285 - Report Public Assistance Fraud Contacts
Report Public Assistance Fraud Contacts Phone Number Eastern 877-770-8055 Southeast 877-860-3052 Central 877-603-4323 Western 877-698-0760 Southwest 877-839-4316
- Covered Medical Services
The services below are covered by all Managed Care Health Plans. Some services are limited based on your age or eligibility group and other services may be available depending on your needs. Work with your provider to see if the service you need is covered.
- 24 hour access by phone
- Ambulance
- Ambulatory surgical center
- Asthma*
- Behavioral health services
- Birthing centers
- Chiropractic services*
- Complementary health and alternative therapy for chronic pain*
- Comprehensive day rehabilitation*
- Dental*
- Diabetes education and self-management training*
- Diabetes Prevention Program*
- Doctor’s office visits
- Doula services
- Durable medical equipment (e.g., oxygen, wheelchairs, walkers)*
- Emergency room
- Family planning services
- Habilitative services*
- Healthy Children & Youth services
- Hearing aids and related services*
- Home health services *
- Hospice, in last 6 months of life*
- Inpatient/outpatient services
- Laboratory tests and x-rays
- Local health services (immunizations)
- Maternity services
- Nurse midwife
- Nursing facility
- Occupational therapy services*
- Personal care
- Pharmacy (through Fee For Service)
- Physical therapy services*
- Podiatry*
- Preventative care (well checks, mammograms, cancer screenings)
- Sexually transmitted diseases
- Specialist care (with referral)
- Speech therapy services*
- Substance use treatment
- Tobacco cessation counseling
- Transplant related services
- Transportation to medical appointments*
- Treat no transport services
- Tuberculosis
- Vision*
*Services may be limited or not covered based on your eligibility. To learn more, visit Benefits and Services at mydss.mo.gov/mhd/benefits. Call your Managed Care Health Plan for more information.
- About Advocates for Family Health (Legal Aid and Services)
Advocates for Family Health is an ombudsman service. An ombudsman is a problem solver who can advise and help you. Advocates for Family Health can help you if:
- You need help understanding your rights and benefits under MO HealthNet Managed Care
- You feel your rights to health care are being denied
- You are not able to solve the problem by talking to a nurse, primary care provider or your MO HealthNet Managed Care health plan
- You need to talk to someone outside of your MO HealthNet Managed Care health plan
- You are not sure how to make a grievance or need help filing
- You need help when appealing a decision by your health plan
- You need help requesting a State Fair Hearing
- For help, contact the office for your county.
- Find Your Office
Missouri County Legal Aid Office Adair Eastern Andrew Western Atchison Western Audrain Mid-Missouri Barry Southern Barton Western Bates Western Benton Western Bollinger Southern Boone Mid-Missouri Buchanan Western Butler Southern Caldwell Western Callaway Mid-Missouri Camden Western Cape Girardeau Southern Carroll Western Carter Southern Cass Western Cedar Southern Chariton Mid-Missouri Christian Southern Clark Eastern Clay Western Clinton Western Cole Mid-Missouri Cooper Mid-Missouri Crawford Southern Dade Southern Dallas Southern Daviess Western DeKalb Western Dent Southern Douglas Southern Dunklin Southern Franklin Eastern Gasconade Southern Gentry Western Greene Southern Grundy Western Harrison Western Henry Western Hickory Western Holt Western Howard Mid-Missouri Howell Southern Iron Southern Jackson Western Jasper Western Jefferson Eastern Johnson Western Knox Eastern Laclede Southern Lafayette Western Lawrence Southern Lewis Eastern Lincoln Eastern Linn Western Livingston Western Macon Eastern Madison Southern Maries Southern Marion Eastern McDonald Western Mercer Western Miller Mid-Missouri Mississippi Southern Moniteau Mid-Missouri Monroe Eastern Montgomery Eastern Morgan Western New Madrid Southern Newton Western Nodaway Western Oregon Southern Osage Mid-Missouri Ozark Southern Pemiscot Southern Perry Southern Pettis Western Phelps Southern Pike Eastern Platte Western Polk Southern Pulaski Southern Putnam Western Ralls Eastern Randolph Mid-Missouri Ray Western Reynolds Southern Ripley Southern Saint Charles Eastern Saint Clair Western Saint Francois Southern Saint Louis County Eastern Saint Louis City Eastern Sainte Genevieve Southern Saline Western Schuyler Eastern Scotland Eastern Scott Southern Shannon Southern Shelby Eastern Stoddard Southern Stone Southern Sullivan Western Taney Southern Texas Southern Vernon Western Warren Eastern Washington Eastern Wayne Southern Webster Southern Worth Western Wright Southern - Western Missouri
Legal Aid of Western Missouri
4001 Dr. Martin Luther King, Jr. Blvd. Suite 300
Kansas City, MO 64130
Phone: 816-474-6750
Fax: 816-474-9751- Eastern Missouri
Legal Services of Eastern MO
701 Market Street, Suite 1100
St. Louis, MO 63101
Phone: 314-534-4200
Toll free: 800-444-0514
Fax: 314-534-1028- Mid-Missouri
Mid-MO Legal Services
117 North Garth
Columbia, MO 65203
Phone: 573-442-0116
Toll free: 800-735-2966
Fax: 573-875-0173- Southern Missouri
Legal Services of Southern MO
3130 South Delaware
Springfield, MO 65804
Phone: 417-881-1397
Toll free: 800-444-4863
Fax: 417-881-2159
- Non-Discrimination Notice
The MO HealthNet Division complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. MO HealthNet Division does not exclude people or treat them differently because of race, color, national origin, age, disability or sex.
The MO HealthNet Division:
- Provides aids and services to people with disabilities at no cost, to communicate effectively with us, such as:
- Qualified sign language interpreters
- Written information in other formats (large print, audio, accessible electronic formats, other formats)
- Provides language services at no cost, to people whose primary Language is not English, such as:
- Qualified interpreters
- Information written in other languages
If you need a qualified interpreter, written information in other formats, translation or other services, call the MO HealthNet Managed Care Enrollment Helpline at 800-348-6627.
If you believe the MO HealthNet Division has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability or sex, you can file a grievance with the Missouri Department of Social Services, Office for Civil Rights at 800-776-8014; or 866-735-2460 (Voice); 800-735-2966 (Text).
Complaints may also be filed by writing to:
Missouri DSS Office for Civil Rights
P.O. Box 1527
Jefferson City, MO 65102-1527.You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at: ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:
U.S. Department of Health and Human Services
200 Independence Avenue
SW Room 509F, HHH Building
Washington, D.C. 20201
800-368-1019, or TDD at 800-537-7697Complaint forms are available online at: hhs.gov/civil-rights/filing-a-complaint/complaint-process/index.html
- Provides aids and services to people with disabilities at no cost, to communicate effectively with us, such as:
- Equal Opportunity Provider
The Missouri Department of Social Services is an equal opportunity provider.