Missouri Medicaid / MO HealthNet Long Term Care Programs, Benefits & Eligibility Requirements
Summary
Medicaid is a joint federal and state program, so its rules, coverage plans and even its name all vary by state. This article focuses on Missouri Medicaid Long Term Care, which is different from regular Medicaid. In Missouri, Medicaid is called MO HealthNet. Missouri residents can receive long-term care benefits through MO HealthNet in a nursing home, in their home and in other residential settings through one of three programs – Nursing Home / Institutional Medicaid, Home and Community Based Service (HCBS) Waivers or Aged Blind and Disabled (ABD) Medicaid.
Missouri Medicaid Long Term Care Programs
Nursing Home / Institutional Medicaid
Missouri Medicaid, which is called MO HealthNet, will cover the cost of long-term care in a nursing home for eligible Missouri residents who require a Nursing Facility Level of Care. Nursing home coverage includes payment for room and board, as well as all necessary medical and non-medical goods and services. These can include skilled nursing care, physician’s visits, prescription medication, medication management, mental health counseling, social activities and assistance with the Activities of Daily Living (eating, bathing, moving, dressing, toileting). Nursing Home Medicaid is an entitlement, which means that all eligible applicants are guaranteed by law to receive the benefits.
Some of the things that MO HealthNet won’t cover in a nursing home are a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example), personal reading items, plants, flowers, and any care services not considered medically necessary.
Any MO HealthNet beneficiary who receives nursing home coverage must give most of their income to the state to help pay for the cost of the nursing home. They are only allowed to keep a “personal needs allowance” of $50 / month. This can be spent on personal items such as clothes, snacks, books, haircuts, cell phones, etc. It cannot be spent on any item that Medicaid covers, including hygiene basics like a toothbrush, soap, deodorant, razors and incontinence supplies, unless the beneficiary wants a specific brand that is not covered by MO HealthNet. In this case, they could spend their personal needs allowance on the item.
Home and Community Based Service (HCBS) Waivers
Home and Community Based Service (HCBS) Waivers will pay for long-term care services and supports that help MO HealthNet (Missouri Medicaid) recipients who require a Nursing Facility Level of Care, but choose to remain living “in the community” instead of moving to a nursing home. For HCBS Waivers in Missouri, “living in the community” means living in one’s own home or the home of a loved one. To determine if the Nursing Facility Level of Care requirement is met in terms of HCBS Waivers, Missouri uses the interRAI Home Care assessment tool.
HCBS Waivers in Missouri are not an entitlement, which means that eligible applicants are not guaranteed by law to receive benefits. Instead, Missouri HCBS Waivers have a limited number of enrollment spots and once those spots are full, additional eligible applicants are placed on a waiting list. This is different than Missouri’s Nursing Home Medicaid and Aged Blind and Disabled / Regular Medicaid, which are both entitlements and every eligible applicant is guaranteed by law to receive benefits.
Missouri has two HCBS Waivers that provide long-term care benefits:
Aged and Disabled Waiver (ADW)
Missouri’s Aged and Disabled Waiver (ADW) provides some long-term services and supports to MO HealthNet (Missouri Medicaid) beneficiaries who are age 65 and older. Physically disabled MO HealthNet beneficiaries who are age 63-64 can also receive ADW benefits. ADW program participants must live in their own home or the home of a loved one, they can not live in an assisted living residence or adult foster care and receive ADW services. The ADW is meant to support unpaid caregivers, who are often family members.
Aged and Disabled Waiver (ADW) benefits include case management, meal delivery, housekeeping services, respite care for the primary caregiver and adult day health care in a community group setting for up to 10 hours per day, five days per week. Transportation to and from the adult day health care center, if necessary, is also an available ADW benefit. MO HealthNet beneficiaries interested in applying for the ADW should contact their local family support office for a referral.
Structured Family Caregiving Waiver (SFCW)
Missouri’s Structured Family Caregiving Waiver (SFCW) provides long-term care services and supports for MO HealthNet (Missouri Medicaid) beneficiaries with Alzheimer’s disease or related dementias who live in a private residence with an unpaid caregiver, who can be a non-relative or a relative, including spouses and legal guardians. This unpaid caregiver can receive financial support through the SCFW program. After acceptance into the SCFW program, the caregiver will become employed and paid by a Structured Family Caregiving provider agency enrolled with the Missouri Department of Social Services.
The caregiver and the MO HealthNet / SCFW beneficiary must live in the same residence. The caregiver can be compensated for providing long-term services and supports such as medication management, housekeeping, transportation and assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting).
Aged Blind and Disabled / Regular Medicaid
Missouri’s Aged Blind and Disabled (ABD) Medicaid (which is also known as Regular Medicaid) provides healthcare and long-term care services and supports to low-income Missouri residents who are aged (age 65+) or disabled and live “in the community.” Living “in the community” in terms of Missouri ABD / Regular Medicaid means living in one’s home, the home of a loved one, assisted living facilities or residential care facilities. While MO HealthNet (Missouri Medicaid) will cover some services in those settings, it will not cover room and board costs. Missouri’s ABD / Regular Medicaid, like ABD Medicaid in all states, is an entitlement, which means that all eligible applicants are guaranteed by law to receive benefits.
Missouri ABD / Regular Medicaid beneficiaries can receive long-term care services and supports through three programs:
Home and Community Based Services
Missouri’s Home and Community Based Services program provides long-term care services and supports for MO HealthNet ABD Medicaid beneficiaries who live in their own home or the home of a loved one and require a Nursing Facility Level of Care. This program is intended to support unpaid caregivers. Its benefits include adult day care, meal delivery, housekeeping assistance, respite care for the primary caregiver, nursing services (such as blood draws, diabetic nail care, medication set-ups) and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting).
Consumer Directed Services (CDS)
Missouri’s Consumer Directed Services (CDS) Program allows MO HealthNet ABD Medicaid beneficiaries who live in their own home or the home of a loved one and require a Nursing Facility Level of Care to hire personal care providers of their choosing, including family members. These caregivers will be paid by the state to perform necessary long-term care services that include meal preparation, housekeeping, transportation, medication management, maintenance of medical equipment and personal care assistance with the Activities of Daily Living (mobility, dressing, bathing, eating, toileting).
Supplemental Nursing Care (SNC) Assistance
Missouri’s Supplemental Nursing Care (SNC) Assistance program provides cash assistance to MO HealthNet ABD Medicaid beneficiaries to cover the cost of living in licensed assisted living facilities and residential care facilities. SNC program participants are required to need help with their Activities of Daily Living (mobility, bathing, dressing, eating, toileting) to be eligible. Missouri uses an Initial Assessment – Social and Medical form to determine that level of care is required.
For 2022, the Supplemental Nursing Care (SNC) Assistance program will provide up to $156 / month for individuals living in residential care facilities plus a $50 / month personal needs allowance, and it will provide up to $156 / month for individuals living in assisted living facilities plus a $50 / month personal needs allowance. The SNC program will also pay $390 / month to individuals who live in a non-Medicaid approved nursing home, but the cost of these nursing homes are so expensive that individuals who would qualify for the SNC program and need a Nursing Facility Level of Care are better off applying for Nursing Home Medicaid through MO HealthNet (Missouri Medicaid).
The Supplemental Nursing Care (SNC) Assistance program is an entitlement, so the state does not limit the number of participants. However, there may be waiting lists for individual facilities if they do not have the space to accept to new residents.
Eligibility Criteria For Missouri Medicaid’s Long Term Care Programs
To be eligible for Missouri Medicaid, which is called MO HealthNet, a person has to meet certain financial requirements and functional (medical) requirements. The financial requirements vary by the applicant’s marital status, if their spouse is also applying for Medicaid, and what program they are applying for – Nursing Home / Institutional Medicaid, Home and Community Based Service (HCBS) Waivers or Aged Blind and Disabled (ABD) Medicaid / Regular Medicaid.
Missouri Nursing Home Medicaid Eligibility Criteria
Financial Requirements
Missouri residents have to meet an asset limit and an income limit in order to be financially eligible for nursing home coverage through MO HealthNet (Missouri Medicaid). For a single applicant in 2022, the asset limit is $5,301.85, which means they must have $5,301.85 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the red box below for more details), and there are other non-countable assets like funeral trusts and Medicaid-approved annuities. All income for a single applicant in Missouri in 2022 must be paid toward the cost of nursing home care with the exception of a $50 / month “personal needs allowance,” Medicare premium payments for applicants who are dual eligible and any allowable spousal income payments to low-income, non-applicant spouses. Almost all income is counted (IRA payments, pension payments, Social Security benefits, property income, stock dividends, alimony, wages, etc.) other than COVID-19 stimulus checks and Holocaust restitution payments.
For married applicants with both spouses applying, the 2022 asset limit for nursing home coverage through MO HealthNet (Missouri Medicaid) is $10,603.70, and all of the couples’ income must be paid toward the cost of nursing home care with the exception of a $50 / month “personal needs allowance” per spouse and Medicare premium payments for applicants who are dual eligible. For a married applicant with just one spouse applying, the 2022 asset limit is $5,301.85 for the applicant spouse and $137,400 for the non-applicant spouse. The income of the non-applicant spouse is not counted, but all of the applicant’s income must be paid toward the cost of nursing home care with the exception of a $50 / month “personal needs allowance,” Medicare premium payments for applicants who are dual eligible and any allowable spousal income payments to low-income, non-applicant spouses.
MO HealthNet (Missouri Medicaid) applicants are not allowed to give away their assets in order to get under the asset limit. To make sure they don’t, Missouri has a “look-back” period of five years. This means the state will look back into the previous five years of the applicant’s financial records to make sure they have not given away assets.
Functional Requirements
The functional, or medical, criteria for nursing home coverage through MO HealthNet (Missouri Medicaid) is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that can only be provided in a nursing home. To determine if the NFLOC requirement is met for Medicaid purposes, Missouri uses the interRAI Home Care assessment tool.
Missouri Medicaid Home and Community Based Service (HCBS) Waivers Eligibility Criteria
Financial Requirements
Missouri residents have to meet an an asset limit and an income limit in order to be financially eligible for the state’s two Home and Community Based Service (HCBS) Waiver programs – Aged and Disabled Waiver (ADW) and Structured Family Caregiving Waiver (SFCW). For a single ADW or SFCW applicant in 2022, the asset limit is $5,301.85 which means they must have $5,301.85 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the red box below for more details), and there are other non-countable assets like funeral trusts and Medicaid-approved annuities. The 2022 income limit for a single ADW applicant is $1,470 / month, while the 2022 income limit for a single SFCW applicant is $963 / month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.
For married applicants with both spouses applying, the 2022 asset limit for both the ADW and SFCW in Missouri is $10,603.70. The 2022 income limit for married ADW applicants with both spouses applying is $1,470 / month per spouse, while the 2022 income limit for married SFCW applicants is $963 / month per spouse. For a married applicant with just one spouse applying, the 2022 asset limit for both the ADW and SFCW is $5,301.85 for the applicant spouse and $137,400 for the non-applicant spouse. The ADW income limit is $1,470 / month for the applicant, and $963 / month for SFCW applicants, but the income of the non-applicant spouse is not counted for either the ADW or the SFCW.
MO HealthNet (Missouri Medicaid) applicants are not allowed to give away their assets in order to get under the asset limit. To make sure they don’t, Missouri has a “look-back” period of five years. This means the state will look back into the previous five years of the applicant’s financial records to make sure they have not given away assets.
Functional Requirements
The functional, or medical, criteria for Home and Community Based Service (HCBS) Waivers through MO HealthNet (Missouri Medicaid) is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that can only be provided in a nursing home. To determine if the NFLOC requirement is met for Medicaid purposes, Missouri uses the interRAI Home Care assessment tool.
Missouri Aged Blind and Disabled Medicaid Eligibility Criteria
Financial Requirements
Missouri residents have to meet an asset limit and an income limit in order to be financially eligible for MO HealthNet’s Aged Blind and Disabled (ABD) Medicaid / Regular Medicaid. For a single applicant in 2022, the asset limit is $5,301.85, which means they must have $5,301.85 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the red box below for more details), and there are other non-countable assets like funeral trusts and Medicaid-approved annuities. The 2022 income limit for a single applicant is $963 / month. Almost all income is counted (IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc.) other than COVID-19 stimulus checks and Holocaust restitution payments.
For married applicants, the 2022 asset limit for MO HealthNet’s ABD / Regular Medicaid is $10,603.70 combined between the two applicants/spouses, and the income limit is $1,297 / month combined. These limits apply to married couples with both spouses applying and married couples with just one spouse applying.
MO HealthNet ABD / Regular Medicaid applicants are not allowed to give away their assets in order to get under the asset limit. To make sure they don’t, Missouri has a “look-back” period of five years. This means the state will look back into the previous five years of the applicant’s financial records to make sure they have not given away assets.
Functional Requirements
The functional requirements for MO HealthNet’s Aged Blind and Disabled (ABD) Medicaid are being disabled, blind or aged (65 or over). MO HealthNet (Missouri Medicaid) will conduct an assessment of ABD / Regular Medicaid applicants and their ability to perform Activities of Daily Living (mobility, bathing, dressing, eating, toileting) to determine the kind of long-term care services the beneficiary needs and the state will cover.
One’s home is often their most valuable asset, and if counted toward the asset limit for MO HealthNet (Missouri Medicaid), it would likely cause them to be over the limit for eligibility. However, in some situations the home is not counted against the asset limit. If the applicant lives in their home and the home equity interest is less than $636,000 (as of 2022), then the home is exempt from the asset limit. Home equity interest is portion of the home’s equity value that the applicant owns, and the home’s equity value is the current value of the home minus any outstanding mortgage / debt against the home. If the applicant’s spouse, minor child, or blind or disabled child of any age lives there, the home is exempt regardless of the applicant’s home equity interest, and regardless of where the applicant lives. If none of the above-mentioned people live in the home, the home can be exempt if the applicant/beneficiary files an “intent to return” home and the home equity interest is at or below $636,000. These rules apply to all three types of Medicaid.
Applying For Missouri Medicaid Long Term Care Programs
The first step in applying for MO HealthNet (Missouri Medicaid) Long Term Care coverage is deciding which of the three Medicaid programs discussed above you or your loved one wants to apply for – Nursing Home Medicaid, Home and Community Based Service (HCBS) Waivers or Aged Blind and Disabled (ABD) Medicaid / Regular Medicaid.
The second step is determining if the applicant meets the financial and functional criteria, also discussed above, for that Long Term Care program. Applying for MO HealthNet (Missouri Medicaid) when not financially eligible will result in the application, and benefits, being denied.
During the process of determining financial eligibility, it’s important to start gathering documentation that clearly details the financial situation for the MO HealthNet (Missouri Medicaid) applicant. These documents will be needed for the official Medicaid application. Necessary documents include five years of quarterly bank statements from all accounts; the most recent monthly or quarterly statements from all investments, IRAs, 401Ks, annuities and any other financial accounts; a letter from the Social Security Administration showing the applicant’s gross Social security income and deductions; tax forms to verify income streams including wages, pensions, royalties and interest; lists of items of any trusts; proof life insurance (if the applicant has any) and a list of beneficiaries; Power of Attorney documentation.
After financial eligibility requirements are checked and double checked, documentation is gathered, and functional eligibility is clarified, Missouri residents can apply for MO HealthNet (Missouri Medicaid) online at myDSS. They can also find an application here.
MO HealthNet beneficiaries interested in applying for the Aged and Disabled Waiver should contact their local family support office for a referral. To apply for the Structured Family Caregiving Waiver, MO HealthNet beneficiaries can contact Missouri’s Division of Senior and Disability Services at 866-835-3505. To apply for the Supplemental Nursing Care Program, MO HealthNet beneficiaries should fill out the “Addendum to MO HealthNET Application: Request for Optional Cash Benefits,” (form number IM-1MAC) and they should check the Supplemental Nursing Care box when filling out the application.
Choosing a Missouri Medicaid Nursing Home
After an applicant has been approved for nursing home coverage through MO HealthNet (Missouri Medicaid), they need to choose which Medicaid-approved nursing home they will live in. Even though Medicaid nursing home coverage is an entitlement, MO HealthNet will only cover stays and care in approved nursing homes. Missouri residents can search for a nursing home by county or city, and see how it did on its last inspection, using this Missouri Department of Health & Senior Services locator. And this is a complete directory of nursing homes in list form. Missouri residents can also use Nursing Home Compare, which is a federal government website that has information about more than 15,000 nursing homes across the country. All of the nursing homes on this site are either Medicaid- or Medicare-approved.