An Overview of MO HealthNet & the Children’s Health Insurance Program
Background
Medicaid is a health insurance program that provides medical coverage for children and adults with low-incomes, pregnant women, seniors, and people with disabilities so they can get and stay healthy. It is jointly funded as a partnership between the state and federal government. Missouri’s Medicaid program is called MO HealthNet.
Medicaid:
- Improves both health and economic outcomes for Missourians,
- Is key to our state’s health care infrastructure, and
- Makes possible critical federal funding that not only supports Medicaid, but provides vital revenue that stabilizes Missouri’s entire state budget (including non-health care services).
Medicaid patients are more likely than the uninsured to access preventive care, including prenatal care and vaccinations for kids.
- Expanded Medicaid coverage has been proven to reduce maternal and infant mortality, primarily due to increased access and utilization of prenatal and postpartum care.
- Children whose parents are covered by Medicaid are 29% more likely to receive preventive care, such as well-child visits.
Medicaid paid more than half (61%) of total U.S. spending on all Long-Term Services and Supports. In Missouri, Medicaid is the primary payer for about 2/3 of nursing facility residents.
Who Qualifies for MO HealthNet?
Although Medicaid was created to serve as a safety net for families and individuals with low incomes, not all Missourians living in poverty qualify. The primary categories of Medicaid eligibility are as follows:

* There are numerous other eligibility categories, such as children in foster care, eligibility through waivers, etc., but most Missourians fall into the categories listed here.
Eligibility & Coverage for Older Adults & People Living with
Disabilities
Most older adults and qualifying people with disabilities have Medicare coverage for their primary health care. For some low-income older adults (sometimes called “dual eligibles”), Medicaid supplements Medicare by helping to cover costs associated with that primary care, like co-pays or premiums. In general, however, these categories of eligibility are designed primarily to cover long-term services and supports (in both institutional and home-based settings) that Medicare does NOT cover.

As such, these categories of eligibility require applicants to meet additional criteria, including:
- Asset Test: Cannot have property/assets valued above certain limits; these limits vary by category of eligibility.
- Level Of Care Determination: To qualify for home and community based services, recipients must also meet Nursing Home Level of Care (NHLOC) criteria. In October 2024, Missouri implemented a new NHLOC algorithm; existing clients will be reassessed on a rolling basis.
- Spend Down: Monthly income is reduced by the amount spent on medical expenses in order to determine eligibility.
Note: Individuals may also meet “spend down” requirements with a monthly payment to the MO HealthNet Division. See Eligibility Requirements for MO HealthNet Coverage, Missouri Department of Social Services, mydss.mo.gov/media/pdf/eligibility-requirements-mo-healthnet-coverage
Because of the spend-down criteria, many older Missourians and those living with disabilities are eligible at incomes higher than the basic income cut-off might reflect.
Medicaid Plays an Important Role in Health Care Coverage for Rural Missourians
Rural Missourians are more likely to be covered by Medicaid than Missourians who live in urban areas.

- More than one in four Missourians living in rural areas are covered, compared to fewer than one in five in urban areas.
- Individuals in rural areas are less likely to have private health insurance coverage from an employer and are more likely to have low incomes. Medicaid helps to fill that coverage gap so that rural Missourians can access the care they need.
- Medicaid also helps rural health care providers stay afloat, so they can serve everyone in their communities.
- Federal funding for Medicaid is expected to provide $12.7 billion for MO HealthNet in FY 2025. That funding is injected into Missouri’s health care industry, flowing to doctors, nurses, and mental health providers. This funding is critical to the health care infrastructure of rural Missouri.
Medicaid Has Long-Term Benefits, Covers Kids Throughout State

Medicaid & CHIP cover about two in five Missouri children.
- In 42 counties, most of them rural, it provides health insurance for more than half of the kids.
- More than 605,000 Missouri kids access health care coverage through MOHealthNet (Missouri’s Medicaid program) or CHIP.
Missouri Charges Higher Premiums for CHIP (That Start at Lower-Income Levels) Than Most States
The Children’s Health Insurance Program (CHIP) allows children in families with incomes above Medicaid limits, but who can’t afford private health insurance, to access health care. Children with incomes above 153% FPL (and newborns with incomes above 201% FPL) are eligible up to 305% FPL.

However, unlike in most states, Missouri requires low-income families to pay premiums for CHIP. Missouri's premiums are far higher than those in other states.

Moreover, Missouri charge premiums to families with lower incomes than other states do.
These premiums contribute to unnecessary gaps in coverage and threaten the well-being of Missouri’s kids. It would only cost Missouri about $3 million to eliminate these premiums.
The Majority of Missouri’s Medicaid Dollars Support Services for Seniors and People with Disabilities

- While children make up the majority of Missouri Medicaid enrollees (50.26%), they only account for 24.87% of the cost of the program.
- The majority of the funding in Medicaid goes toward covering care for seniors and people with disabilities. Although they make up less than 20% of enrollees, they account for about half of Missouri’s Medicaid spending.
- The distribution of Medicaid enrollment and payments for services by enrollment group in Missouri mirrors the national average, where most of the budget is spent caring for those with the most complex medical needs.
Medicaid is a Good Deal for Missouri Taxpayers

- Created as part of the Social Security Act in 1965, Medicaid is a partnership between the state and federal governments.
- Each state enjoys flexibility in designing and managing its program within the parameters of national guidelines. In exchange, the federal government provides the majority of funding.
- In state FY 2025, the federal government will provide $1.88 for each dollar Missouri spends on coverage.
- 86% of Missouri’s Medicaid program is financed through federal funds, provider taxes and other state dedicated funds.
- State general revenue funds only 14% of the total cost of Medicaid in Missouri, making it a good deal for Missouri taxpayers.
Medicaid Provider Taxes Critical to Medicaid, Overall State Budget

- Medicaid provider taxes (commonly referred to as the Federal Reimbursement Allowance, or FRA) are voluntary taxes paid by hospitals, nursing homes, pharmacies and other providers that leverage additional federal funding for health services through Missouri Medicaid.
- In Fiscal Year 2026, the FRA is expected to generate nearly $1.5 billion in state revenue. When used as state match for Medicaid, the FRA draws down more than $2.8 billion in federal funds for health services.
- In context, if FRA were general revenue, it would be the third largest source, behind only individual income tax and sales tax, and bringing in more state funding than the corporate income tax.
The FRA provides critical revenue to support Medicaid. In doing so, it frees up state general revenue to support education and other priorities. Without it, general revenue would be needed in its place.
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