MO HealthNet Eligibility (ME) Codes Explained

Adult Expansion Group (AEG)

•    Age 19 through 64. 
•    Income at or below 138% of the FPL.
•    Not pregnant. 
•    Not entitled to or enrolled in Medicare Part A or B. 
•    Not receiving SSI. 
•    Ineligible for all MO HealthNet mandatory category including M0 HealthNet for Pregnant Women, MO HealthNet for Familie, MO HealthNet for the Aged, Blind & Disabled Non-Spend Down, or Former Foster Children under age 26.

Blind Pension (BP)

•    Is a cash assistance program for persons determined by the State Ophthalmologist to meet Missouri’s definition of blindness (5/200)
•    Must be age 18 or older 
•    Must be ineligible for Supplemental Aid to the Blind (SAB) and SSI
•    Not soliciting alms 
•    Sighted spouse’s income is less than 500% FPL ($8,813/mo. effective 4/1/25)
•    Good Moral Character 
•    If eligible the grant is $917, there is no budget or income limit
•    BP recipients are eligible for State only funded MO HealthNet coverage, which is slightly more restrictive than Medicaid
•    The state only MO HealthNet does not cover HCB waiver services (including DD waivers),or community psychiatric rehabilitation (CPR) services or CSTAR services, but individual can receive BP grant and MHABD coverage in ME code 12 by contacting the DMH Medicaid Eligibility unit (DMH.MedicaidEligibility@dmh.mo.gov)

Supplemental Aid to the Blind (SAB)

• Is a cash assistance program for persons determined by the State Ophthalmologist to meet Missouri’s definition of blindness (5/200)
• Must be age 18 or older
• Must apply for SSI 
• Not soliciting alms 
• (full) Support from a sighted spouse not available 
• SAB budget is for the claimant only
• SAB claimant’s income other than SSI cannot exceed $1,073 (eff. 1/1/26) per month
• SAB grant is the BP grant of $917 (eff. 7/1/25)  minus the claimant’s SSI
• provides automatic federally matched MO HealthNet without a spend down or premium

Aid to the Permanently and Totally Disabled conversion (PTD)

• Is a cash assistance program for people receiving and Aid to the Permanently and Totally Disabled (PTD) cash grant in December 1973 whose PTD grant was more than they would have received in Supplemental Security Income (SSI) on 1/1/74 when PTD cases were converted to SSI.
• provides automatic federally matched MO HealthNet without a spend down or premium

MO HealthNet for Families (MHF) includes Transitional Medical Assistance

• Parents (or relative caretaker) of children under age 19 the home. 
• MAGI household income does not exceed the July 16, 1996 AFDC (current Temporary Assistance) income limit for household size.
• Transitional Medical Assistance continues coverage for 6 to 12 months after the family becomes ineligible for MHF due to increased earnings

Mo HealthNet for Families (MHF) includes Transitional Medical Assistance

• Children (under age 19) in the home of a parent (or relative caretaker). 
• MAGI household income does not exceed the July 16, 1996 AFDC (current Temporary Assistance) income limit for household size.
• Transitional Medical Assistance continues coverage for 6 to 12 months after the family becomes ineligible for MHF due to increased earnings

Children in the custody of the Department of Social Services Children's Division 

• Transitional Medical Assistance continues coverage for 6 to 12 months after the family becomes ineligible for MHF due to increased earnings

Children in the custody of Department of Social Services Children's Division or a former foster child under age 26

• Determined by Children’s Division to be ineligible for federally matched Medicaid due to institutional status
• Coverage is state only funded MO HealthNet which is slightly more restrictive than Medicaid and does not cover HCB waiver services (including DD waivers), community psychiatric rehabilitation (CPR) services, or CSTAR services. 

Children in the custody of the Department of Social Services Children's Division

• Child is not eligible for Title IV-E or federally matched Medicaid due to income or citizenship/immigration status
• Coverage is state only funded MO HealthNet which is slightly more restrictive than Medicaid and does not cover HCB waiver services (including DD waivers), community psychiatric rehabilitation (CPR) services, or CSTAR services. 

MO HealthNet for the Aged, Blind, Disabled (MHABD) - Aged 65 & over

• Available resource limit (effective 7/1/25) is $6,068.80 for a single individual, $12,137.55 for a married couple 

ME code includes: 

• spend down/non-spend down eligibility:
• non-spend down income limit is 85% of federal poverty level (FPL) - $1,109 single individual / $1,499 married couple eff. 4/1/25) 
• spend down is equal to the amount of countable income above 85% of FPL
• vendor coverage for patients in nursing facilities or state institutions, 
• Special Income Level (SIL) of $1,737 (eff. 1/1/26) for participants enrolled in Aged & Disabled HCB waiver
• SSI and former SSI recipients in is Section 1619(a)&(b) status

MO HealthNet for the Aged, Blind, Disabled (MHABD) - blind

includes: 

• Must meet Missouri’s definition of blindness (5/200) as determined by the FSD Medical Review Team (MRT) state ophthalmologist. 
• Must be age 18 or older.
• Available resource limit (effective 7/1/25) is $6,068.80 for a single individual, $12,137.55 for a married couple

ME code includes: 

• spend down/non-spend down, 
  • non-spend down income limit is 100% of federal poverty level (FPL) - $1,305 single individual / $1,763 married couple eff. 4/1/25) 
  • spend down is equal to the amount of countable income above 100% of FPL
• vendor coverage for patients in nursing facilities or state institutions, 
• Special Income Level (SIL) of $1,737 (eff. 1/1/26) for participants age 63 and over enrolled in Aged & Disabled HCB waiver

SSI and former SSI recipients in is Section 1619(a)&(b) status

MO HealthNet for the Aged, Blind, Disabled (MHABD) - disabled

• Must have a disability that meets Social Security’s definition, disability is established by:
  • receipt of SSDI or SSI; or 
  • a determination by the FSD Medical Review Team (MRT 
• Available resource limit (effective 7/1/25) is $6,068.80 for a single individual, $12,137.55 for a married couple

ME code includes: 

• spend down/non-spend down eligibility:
  • non-spend down income limit is 85% of federal poverty level (FPL) - $1,109 single individual / $1,499 married couple eff. 4/1/25) 
  • spend down is equal to the amount of countable income above 85% of FPL
• vendor coverage for patients in nursing facilities or state institutions, 
• Special Income Level (SIL) of $1,737 (eff. 1/1/26) for participants age 63 and over enrolled in Aged & Disabled HCB waiver
• SSI and former SSI recipients in is Section 1619(a)&(b) status

disabled children under age 18 (a portion of parents’ income is deemed available to the child)

Supplemental Nursing Care (SNC) - aged 65 & Over

• Is a cash assistance program for people living in a: 
  • Residential Care Facility (RCF), 
  • Assisted Living Facility (ALF, formerly RCF II), or 
  • non-vendor Nursing Facility
• Provides automatic MO HealthNet eligibility without a spend down or premium
• Available resource limit (effective 7/1/25) is $6,068.80 for a single individual, $12,137.55 for a married couple.  Eligibility unit for resource determination includes the spouse 
• Cash grant is the difference between the facility’s base rate and the participant’s income, up the maximum of:
  • $156 for RCF, 
    • $292 for ALF or RCF II, 
    • $390 for NF, requires a need for institutional level of care determination by DHSS
  • Assistance group for the budget is the participant only
  • Only income disregard is from Supported Employment earnings: the first $65/month and one half the remainder
• Non-DMH placements receive a separate $50 personal needs check

Supplemental Nursing Care (SNC) - blind

• Is a cash assistance program for people living in a: 
  • Residential Care Facility (RCF), 
  • Assisted Living Facility (ALF, formerly RCF II), or 
  • non-vendor Nursing Facility
• Provides automatic MO HealthNet eligibility without a spend down or premium
• Must meet Missouri’s definition of blindness (5/200) as determined by the FSD Medical Review Team (MRT) state ophthalmologist
• Must be age 21 or older
• Available resource limit (effective 7/1/25) is $6,068.80 for a single individual, $12,137.55 for a married couple. Eligibility unit for resource determination includes the spouse 
• Cash grant is the difference between the facility’s base rate and the participant’s income, up the maximum of:
  • $156 for RCF, 
    • $292 for ALF or RCF II, 
    • $390 for NF, requires a need for institutional level of care determination by DHSS
  • Assistance group for the budget is the participant only
  • Only income disregard is from Supported Employment earnings: the first $65/month and one half the remainder

Non-DMH placements receive a separate $50 personal needs check

Supplemental Nursing Care (SNC) - disabled

• Is a cash assistance program for people living in a: 
  • Residential Care Facility (RCF), 
  • Assisted Living Facility (ALF, formerly RCF II), or 
  • non-vendor Nursing Facility
• Provides automatic MO HealthNet eligibility without a spend down or premium
• Must have a disability that meets Social Security’s definition, disability is established by:
  • receipt of SSDI or SSI; or 
  • a determination by the FSD Medical Review Team (MRT 
• Must be age 21 or older
• Available resource limit (effective 7/1/25) is $6,068.80 for a single individual, $12,137.55 for a married couple.  Eligibility unit for resource determination includes the spouse 
• Cash grant is the difference between the facility’s base rate and the participant’s income, up the maximum of:
  • $156 for RCF, 
    • $292 for ALF or RCF II, 
    • $390 for NF, requires a need for institutional level of care determination by DHSS
  • Assistance group for the budget is the participant only
  • Only income disregard is from Supported Employment earnings: the first $65/month and one half the remainder
  • Non-DMH placements receive a separate $50 personal needs check

MO HealthNet for Pregnant Women (MPW)

• Pregnant. 
• MAGI household income does not exceed the MO HealthNet for Families limit (July 16, 1996 AFDC limit) for household size which includes the including unborn child.
• Coverage continues until the last day of the month the pregnancy ends

MO HealthNet for Children in a vendor institution ME codes

• Child under age 19
• Residing in a nursing facility or psychiatric facility for over 30 days
• MAGI income of the child does not exceed the July 16, 1996 AFDC (current Temporary Assistance) income limit for a household of one

Children in the custody of the Department of Social Services Division of Youth Services

• MAGI income of the child does not exceed the July 16, 1996 AFDC (current Temporary Assistance) income limit for a household size of one.

Children in the custody of a juvenile court

• MAGI income of the child does not exceed the July 16, 1996 AFDC (current Temporary Assistance) income limit for a household size of one

MOCDD (Sara Lopez) waiver SIL category

• Under age 18
• Child is authorized by DMH Division of Developmental Disabilities for services from the MOCDD waiver.
• Special Income Level (SIL) of $1,737 (eff. 1/1/26) 
• Available resource limit (effective 7/1/25) is $6,068.80
• Income and resources of the parents are excluded

MOCDD (Sara Lopez) waiver SIL category

• Under age 18
• Child is authorized by DMH Division of Developmental Disabilities for services from the MOCDD waiver.
• Special Income Level (SIL) of $1,737 (eff. 1/1/26) 
• Available resource limit (effective 7/1/25) is $6,068.80
• Income and resources of the parents are excluded

Children receiving an adoption subsidy from the Department of Social Services Children’s Division

• MAGI income of the child does not exceed the 153% FPL for a household size of one
• Ineligible for Title IV-E

Children in the custody of the Department of Social Services Children’s Division

• MAGI income of the child does not exceed the 153% FPL for a household size of one
• Ineligible for Title IV-E

Former Foster Child under age 26 

• Participant was in foster care when they turned age 18
• Coverage continues until participant turns age 26

MO HealthNet for Kids (MHK) poverty 

• Under age 19 
• MAGI household income does not exceed 153% FPL for household size

MO HealthNet for Children in a vendor institution

• Child under age 19
• Residing in a nursing facility or psychiatric facility for over 30 days
• MAGI income of the child does not exceed 153% FPL for a household of one

MO HealthNet for Pregnant Women (MPW) post-partum coverage

• 12 months of coverage following the end of a pregnancy for women who were covered in ME code 18 during their pregnancy 

MO HealthNet for Pregnant Women (MPW) post-partum coverage

• 12 months of coverage following the end of a pregnancy for women who were covered in ME code 45 or 61 during their pregnancy

MO HealthNet for Pregnant Women (MPW) – ME codes 18,43,44,45,61

• Pregnant. 
• MAGI household income does not exceed 153% FPL for household size which includes the including unborn child.
• Coverage continues until the last day of the month the pregnancy ends

Children in the custody of the Department of Social Services Division of Youth Services

• MAGI income of the child does not exceed the 153% FPL for a household size of one

Children in the custody of the Department of Social Services Division of Youth Services

• Child is not eligible federally matched Medicaid due to income, citizenship/immigration status, or institutional status
• Coverage is state only funded MO HealthNet which is slightly more restrictive than Medicaid and does not cover HCB waiver services (including DD waivers), community psychiatric rehabilitation (CPR) services, or CSTAR services. 

Qualified Medicare Beneficiary (QMB)

• Must be enrolled in Medicare Part A
• Income limit is 100% FPL ($903 single/$1,215 couple)
• Pays all Medicare cost sharing including premiums and co-pays

Children receiving an adoption subsidy from the Department of Social Services Children’s Division-

• Child is eligible for an adoption subsidy maintenance payment under Section Title IV-E of the Social Security Act

Children receiving an adoption subsidy from the Department of Social Services Children’s Division-

• Determined by Children’s Division to be ineligible for federally matched Medicaid due to institutional status
• Coverage is state only funded MO HealthNet which is slightly more restrictive than Medicaid and does not cover HCB waiver services (including DD waivers), community psychiatric rehabilitation (CPR) services, or CSTAR services. 

Children receiving an adoption subsidy from the Department of Social Services Children’s Division 

• Child is not eligible for Title IV-E or federally matched Medicaid due to income or citizenship/immigration status
• Coverage is state only funded MO HealthNet which is slightly more restrictive than Medicaid and does not cover HCB waiver services (including DD waivers), community psychiatric rehabilitation (CPR) services, or CSTAR services. 

Temporary MO HealthNet for Pregnant Women (TEMP) also known as Presumptive Eligibility for Pregnant Women

• Pregnant
• Authorized for presumptive Medicaid eligibility by a Qualified Entity based on participant’s statement that MAGI household income does not exceed 201% FPL for household size which includes the including unborn child.
• Coverage is only for ambulatory pre-natal care which does not include HCB waiver services (such as DD waivers), community psychiatric rehabilitation (CPR) services, or CSTAR services. 
• Coverage continues from date of determination until: 
  • FSD makes a determination on MO HealthNet for Pregnant Women eligibility if MO HealthNet application is made by the end of the month following the PE determination; or
  • The last day of the month following the PE determination is made if MO HealthNet application is not made

Temporary MO HealthNet for Pregnant Women (TEMP) also known as Presumptive Eligibility for Pregnant Women

• Pregnant
• Coverage is only for ambulatory pre-natal care which does not include HCB waiver services (such as DD waivers), community psychiatric rehabilitation (CPR) services, or CSTAR services. 
• Coverage begins date FSD determines ME code 58 participant is ineligible for MPW and continues through the last day of the month following the PE determination is made. 

Newborns – ME code 60

Child under age 1 born to a mother who was receiving MO HealthNet when child was born.

MO HealthNet for Pregnant Women (MPW) (HIF)

• Pregnant. 
• MAGI household income does not exceed 201% of FPL for household size which includes the including unborn child.
• Coverage continues until the last day of the month the pregnancy ends
• State funding match is from the Missouri Health Initiative Fund (HIF)

MO HealthNet for Kids (MHK) (HIF) 

• Under age 1.
• MAGI household income does not exceed 201% FPL for household size, but is above 153% FPL 
• State funding match is from the Missouri Health Initiative Fund (HIF)

Group Home placement by Children a juvenile court (HIF)

• Child placed in a group home a juvenile court who have not been determined eligible for federally matched Medicaid. 
• Coverage is state only funded MO HealthNet which is slightly more restrictive than Medicaid and does not cover HCB waiver services (including DD waivers), community psychiatric rehabilitation (CPR) services, or CSTAR services. 
• Funding is from the Missouri Health Initiative Fund (HIF)

Children in the custody of the Department of Social Services Children’s Division (HIF)

• Under age 1.
• MAGI household income does not exceed 201% FPL for household size, but is above 153% FPL 
• State funding match is from the Missouri Health Initiative Fund (HIF)

Children in the custody of a juvenile court – HIF

• Under age 1.
• MAGI household income does not exceed 201% FPL for household size, but is above 153% FPL 
• State funding match is from the Missouri Health Initiative Fund (HIF)

Children in the custody of a juvenile court - poverty

• MAGI income of the child does not exceed the 153% FPL for a household size of one

MO HealthNet for Kids (MHK) CHIP non-premium: 

• Children age 1 through 5.
• MAGI household income 149% to 150% FPL 
• Cannot have other health insurance
• Category is now superseded by ME codes 40 and 4M

MO HealthNet for Kids (MHK) CHIP non-premium: 

• Children age 6 through 18.
• MAGI household income does 149% to 150% FPL
• Cannot have other health insurance
• Category is now superseded by ME codes 40 and 4M

MO HealthNet for Kids (MHK) CHIP premium: 

• Under age 19
• MAGI household income above 153% FPL , but does not exceed 185% FPL
• Cannot have other health insurance
• cannot have access to affordable health insurance ($100 to $250/mo based on household size and income)
• family must pay a monthly premium. 

MO HealthNet for Kids (MHK) CHIP premium:

• Under age 19
• MAGI household income above 153% FPL , but does not exceed 18%% FPL
• Cannot have other health insurance
• cannot have access to affordable health insurance ($100 to $250/mo based on household size and income)
• family must pay a monthly premium.

MO HealthNet for Kids (MHK) CHIP premium:

• Under age 19
• MAGI household income above 153% FPL , but is less than 300% FPL
• Cannot have other health insurance
• cannot have access to affordable health insurance ($100 to $250/mo based on household size and income
• family must pay a monthly premium.

MO HealthNet for Kids (MHK) CHIP non-premium: 

• Under 19.
• Cannot have other health insurance
• MAGI household income does not exceed 153% FPL for household size
• MAGI household is above 148% FPL for children ages 1 through 5
• MAGI household is above 110% FPL for children ages 6 through 18

Extended Women’s Health Services (limited primarily to family planning services)

• 12 months of coverage of family planning services after the end of MPW post-partum coverage in ME code 43 or 44 
• Ineligible for any other MO HealthNet program

MORx 

• Only coverage is 50% of Medicare Part D prescription drug co-payments 

MO HealthNet for Women Receiving Breast or Cervical Cancer Treatment (BCCT) – presumptive eligibility 

• Woman under age 65
• Need treatment for breast or cervical cancer
• Screened for breast or cervical cancer by the Show Me Healthy Women program 
• Determined by the Show Me Healthy Women program provider to presumptively meet the requirements for ME code 84

MO HealthNet for Women Receiving Breast or Cervical Cancer Treatment (BCCT) – 

• Woman under age 65
• Need treatment for breast or cervical cancer
• Screened for breast or cervical cancer by the Show Me Healthy Women program (or by a MO HealthNet provider while receiving MO HealthNet)
• provides federally matched MO HealthNet coverage without a spend down or premium and is NOT limited to treatment of breast or cervical cancer

Ticket-to-Work Health Assurance (TWHA) – premium 

• Disabled or have a medically improved condition, disability or medically improved condition is established by 
  • receipt of SSDI, or 
  • a determination by the FSD Medical Review Team (MRT), SGA does not apply to the disability determination or 
• Employed, with Social Security/Medicare taxes withheld or paid
• Age 16 through 64
• Countable income above 100% FPL ($1,305 single individual / $1,763 married couple eff. 4/1/25 ) and not exceeding 250% of FPL ($3,261 single, $4,407 couple eff. 4/1/25)
• Premium – participants must pay a monthly premium: 
  • $52-$196 (eff. 4/1/25) for single individuals, $71-$264 (eff. 4/1/25) for married couples 
• Available resource limit (effective 7/1/25) is $6,068.80 for a single individual, $12,137.55 for a married couple

Ticket-to-Work Health Assurance (TWHA) – non-premium

• Disabled or have a medically improved condition, disability or medically improved condition is established by 
  • receipt of SSDI, or 
  • a determination by the FSD Medical Review Team (MRT), SGA does not apply to the disability determination or 
• Employed, with Social Security/Medicare taxes withheld or paid
• Age 16 through 64
• Countable income does not exceed 100% FPL ($1,305 single individual / $1,763 married couple eff. 4/1/25) 
• Available resource limit (effective 7/1/25) is $6,068.80 for a single individual, $12,137.55 for a married couple

Presumptive Eligibility for Kids

• Authorized for presumptive Medicaid eligibility by a Qualified Entity based on family’s statement that MAGI household income does not exceed 305% FPL for household size.
• Coverage continues from date of determination until: 
  • FSD makes a determination on MO HealthNet for Kids eligibility if MO HealthNet application is made by the end of the month following the PE determination; or
  • The last day of the month following the PE determination is made if MO HealthNet application is not made

Voluntary Placement Agreement

• Children who be taken into custody of DSS or a juvenile court due the need for behavioral health services, but sign a voluntary placement agreement to receive services from DMH

Uninsured Women’s Health Services (limited primarily to family planning services) 

• Women age 18 up to but not including age 56
• Uninsured
• Family MAGI that does not exceed 201% FPL for household size
• Ineligible for any other MO HealthNet program
• No access to employer-sponsored insurance

Show Me Healthy Babies presumptive eligibility

• CHIP coverage for the mother of an unborn child
• Authorized for presumptive eligibility by a Qualified Entity based on participant’s statement that MAGI household income does not exceed 305% FPL for household size which includes the including unborn child.
• Coverage is only for ambulatory pre-natal care which does not include HCB waiver services (such as DD waivers), community psychiatric rehabilitation (CPR) services, or CSTAR services. 
• Coverage continues from date of determination until: 
  • FSD makes a determination on MO HealthNet for Pregnant Women eligibility if MO HealthNet application is made by the end of the month following the PE determination; or
  • The last day of the month following the PE determination is made if MO HealthNet application is not made

Show Me Healthy Babies –

• CHIP coverage for the mother of an unborn child
• MAGI household income between above 196% FPL up to and including 305% FPL for household size (including unborn child). 
• Pregnant women in families with gross income over 150% FPL cannot have access to affordable health insurance ($100 to $250/mo based on household size and income).
• Pregnant woman cannot have employer sponsored or private insurance that covers all of the following:
  • Prenatal services;
  • Labor and Delivery; and
  • Postpartum coverage.
  • If all three are included on other insurance coverage, the individual is not eligible for SMHB. If one of the three services are not covered, the individual is potentially eligible for SMHB

Show Me Healthy Babies – 

• CHIP coverage for the mother of an unborn child
• Mother is ineligible for MO HealthNet for Pregnant Women coverage based on citizenship/immigration status
• MAGI household income does not 305% FPL for household size (including unborn child). 
• Pregnant women in families with gross income over 150% FPL cannot have access to affordable health insurance ($100 to $250/mo based on household size and income)
• Pregnant woman cannot have employer sponsored or private insurance that covers all of the following:
  • Prenatal services
  • Labor and Delivery
  • Postpartum coverage
  • If all three are included on other insurance coverage, the individual is not eligible for SMHB. If one of the three services are not covered, the individual is potentially eligible for SMHB

Show Me Healthy Babies Newborns –

• Child under age 1 born to a mother who was receiving Show Me Healthy Babies coverage when child was born.

Show Me Healthy Babies –  post-partum coverage

• Post-partum CHIP coverage for the mother of a child receiving SMHB coverage following the end of a pregnancy 

Show Me Healthy Babies Newborns 

• Child under age 1 born to a mother who was receiving Show Me Healthy Babies coverage when child was born.

Show Me Healthy Babies Newborns 

• Child under age 1 born to a mother who was receiving Show Me Healthy Babies coverage when child was born.