The qualifications for the MO HealthNet Managed Care program are based on a combination of factors, including family composition, income level, insurance status, or pregnancy status depending on the eligibility group in question. The MO HealthNet Managed Care population consists of different eligibility groups that have been combined into five categories for the purpose of rate setting. The MO HealthNet Managed Care population must
enroll in a MO HealthNet Managed Care health plan. Those that are eligible for Supplemental Security Income (SSI) benefits, children who are enrolled in the Special Health Care Needs Program, or Disabled and 18 or younger may choose not to opt out or not enroll in the MO HealthNet Managed Care Program.
The five categories are Category of Aid (COA) 1, COA 2, COA 4, COA 5, and COA 6. (COA 3 is not in use).
Category Of Aid 1: Parents/Caretakers, Children, and Pregnant Women
| Category of Aid 1
|
ME Codes
|
ME Code Description
|
| MO HealthNet For Families |
05 |
Adult (MHF-AD) |
| 06 |
Child (MHF-CD) |
| MO HealthNet for Families for Poverty Level Children |
40 |
MO HealthNet for Kids - Poverty |
| 62 |
MO HealthNet for Kids - Health Initiative Fund |
| 4M |
MO HealthNet for Kids (CHIP Fund) |
| Newborns |
60 |
Newborns (Eligibility only) |
| 6S |
Show Me Healthy Babies (SMHB) Newborns <186% FPL |
Category Of Aid 2: Pregnant and Post-Partum Women
| Category of Aid 2 |
ME Codes |
ME Code Description |
| MO HealthNet for Pregnant Women |
18 |
Pregnant Women - MPW |
| 43 |
Pregnant Women-60 Day Assistance – MHF Criteria |
| 44 |
Pregnant Women-60 Day Assistance - Poverty |
| 45 |
Pregnant Women-Poverty |
| 61 |
Pregnant Women Health Initiative Fund |
| 95 |
Show Me Healthy Babies Pregnant Women – income above 196% and up to 300% |
| 96 |
Show Me Healthy Babies Unborn Child income 0% to 300% |
| 98 |
Show Me Healthy Babies Post-Partum |
Category Of Aid 4: MO HealthNet Children in the Care and Custody of the State and Receiving Adoption Subsidy Assistance. Covered through Show Me Healthy Kids specialized managed care plan for this population.
| Category of Aid 4 |
ME Codes |
ME Code Description |
| DSS Children’s Division |
07 |
Foster Care - Title IV - E |
| 08 |
Child Welfare Services – Foster Care |
| 37 |
Title XIX-Homeless, Dependent, Neglected |
| 38 |
Independent Foster Care (Ages 18 to 25) |
| 66 |
Foster Care HDN - HIF |
| 0F |
Foster Care – IMD Placement |
| Adoption Subsidy |
36 |
Adoption Subsidy-Federal Financial Participation |
| 56 |
Adoption Subsidy- Title IV - E Eligible |
| 57 |
Child Welfare Services - Foster Care - Adoption Subsidy |
| 5A |
Adoption Subsidy Guardianship IMD Placement |
| DSS Division of Youth Services |
29 |
Div of Youth Services - Foster Care |
| 50 |
Div of Youth Services - Poverty |
| 52 |
Div of Youth Services – General Revenue |
| 68 |
Div of Youth Services Foster Care - HIF |
Category Of Aid 5: MO HealthNet for Kids (CHIP)
| Category of Aid 5 |
ME Codes |
ME Code Description |
| Children’s Health Insurance Program (CHIP) |
71 |
MO HealthNet for Kids 133+ to 150% Age 1-5 (No Cost) |
| 72 |
MO HealthNet for Kids 100+ to 150% Age 6-18 (No Cost) |
| 73 |
Children ages 1 thru 18; family income 150+ to 185% (Premium) |
| 74 |
Children ages 0 thru 18; family income 185+ to 225% (Premium) |
| 75 |
Children ages 0 thru 18; family income 225+ to 300% (Premium) |
| 97 |
Show Me Healthy Babies Newborns Age 0 to 1; Family Income 196+ to 300% (Premium) |
| 9S |
SMHB Newborns >=186% FPL |
Category Of Aid 6: Adult Expansion Group
| Category of Aid 6 |
ME Codes |
ME Code Description |
| Adult Expansion Group |
E2 |
Adult Expansion Group <138% Age 19-64 |
