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 four 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 receive Supplemental Security Income (SSI), meet the medical definition for SSI, or are eligible for adoption subsidy benefits may choose not to enroll or voluntarily disenroll from the MO HealthNet Managed Care Program at any time.

The four categories are Category of Aid (COA) 1, COA 2, COA 4, and COA 5. (COA 3 is not in use).

Category Of Aid 1: Parents/Caretakers, Children, Pregnant Women, and Refugees
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
Newborns 60 Newborns (Eligibility only)
MO HealthNet for Refugees 10 Refugees other than Cuban, Haitian, Russian Jew, or Ethiopian
19 Cuban Refugee
21 Haitian Refugee
24 Russian Jew Refugee
26 Ethiopian Refugee
Category Of Aid 2: Pregnant 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
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
Adoption Subsidy 36 Adoption Subsidy-Federal Financial Participation
56 Adoption Subsidy- Title IV - E Eligible
57 Child Welfare Services - Foster Care - Adoption Subsidy
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
Juvenile Court 30 Juvenile Courts – Foster Care
64 Group Home – Health Initiative Fund (State Placement)
69 Juvenile Court - HIF
70 Juvenile Court - Poverty
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)