MO HOPE: Helping Open Pathways to Eligibility
Department of Social Services | Department of Mental Health
Show Me Challenge 2025 - Provider Education Outline
What is MO HOPE?
MO HOPE is an education initiative empowering providers to use budgeted funds for
selected participants to pay their Medicaid Spend Down, improving access to care and
stabilizing services.
What is Spend Down?
The Spend Down amount is like a deductible based on income – participants must pay or
submit medical bills for the portion above Medicaid’s limit before coverage starts.
Legal – 42 CFR § 435.121 (f)(1)(iii)
This regulation states that expenses that are the responsibility of a third party can be used
for an individual’s spend down if it is part of a state program. Since Certified Community
Behavioral Health Center’s services are part of the State of Missouri’s Department of
Mental Health program they can pay the spend down directly to MO HealthNet.
Timing & Submission Requirements
- Identify participants one month prior to when coverage is needed.
- The list of participants providers are electing to pay Spend Down on behalf of must
reach MO HealthNet within the allowable timeframe to ensure timely activation. - Work with Department of Mental Health (DMH) to submit funds to MO HealthNet on
behalf of selected participants to pay spend down.
Why Participate
Benefits for Clients:
- Access to needed services with care continuity.
- Stability in treatment.
Benefits for Providers:
- Ensures you can bill Medicaid and get paid for services.
- Reduces administrative time chasing alternative payment.
How to Check Coverage
Once the Spend Down payment agreement has been submitted:
- Verify coverage through the MO HealthNet Provider Portal.
- If coverage does not appear active or there are questions, contact the eligibility
specialists or DMH point of contact for troubleshooting.
Questions?
Contact: DMH.MedicaidEligibility@dmh.mo.gov