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Medicaid Program Summary
PROGRAM BENEFITS INCOME LIMITS RESOURCE LIMITS OTHER
REQUIREMENTS
Medical Assistance Medicaid $695* single person; $935* $999.99 for a single Be permanently and
(Non-Vendor) married couple. These amounts individual; $2,000 for a totally disabled (PTD) as
are 85% of the current Federal married couple. ** determined by the
Poverty Level ($817 for a single Missouri Family Support
person and $1,100 for a married Division, be blind, or be
couple). These income at least age 65; or
guidelines are set by state receiving Supplemental
appropriation not to be less than Security Income (SSI) or
the federal Supplemental Security Social Security
Income (SSI) maximum Disability Insurance
(currently $623 for a single benefits (SSDI)
person and $934 for a married
couple).
If income exceeds limits, person
must reduce (spend down)
income on medical expenses or
pay the state a monthly premium
that equals the spend down
amount.
If client meets definition of
blindness, income guideline is
$817* for a single person.
Chart revised on 02/20/2007 by Lee A. Waer, Turnbull Law Office, P. C.; Email Ribull@aol.com 1
Medicaid Program Summary
PROGRAM BENEFITS INCOME LIMITS RESOURCE OTHER REQUIREMENTS
LIMITS
Medical Assistance for Medicaid $695* This amount is 85% of $999.99; Resources Be under age 18
Disabled Children the FPL (currently $817 for a of the child and Be PTD or receiving SSI
single person). The income parents are counted.
guideline is set by state **
appropriation not to be less than
the SSI maximum (currently
$623 for a single person). If
income exceeds limits, child
must reduce (spend down)
income on medical expenses or
pay the state a monthly premium
that equals the spend down
amount. Net parental income is
counted using SSI methodology.
Missouri Children with Medicaid $1,088*; The parents’ income is $999.99; No Be under age 18
Developmental not deemed toward the child. resources belonging Transfers of property within
Disabilities Waiver to the parents are 60 months of the application
program (Sara Lopez deemed toward the may cause ineligibility***
waiver) child. ** Be PTD or gets SSI
Determined by the
Department of Mental
Health (DMH) to need
Intermediate Care
Facility/Mental Retardation
level of care and be
authorized to receive waiver
services
Chart revised on 02/20/2007 by Lee A. Waer, Turnbull Law Office, P. C.; Email Ribull@aol.com 2
Medicaid Program Summary
PROGRAM BENEFITS INCOME LIMITS RESOURCE LIMITS OTHER
REQUIREMENTS
Medical Assistance -- Medicaid $1,088* for person $999.99 for an Be at least age 63
Home and Community needing HCB services. individual; $2,000 for a Transfers of property
Based (HCB) waiver For a married couple, married couple when within 60 months of
income of the non-HCB both require HCB the application may
spouse is not counted services. ** cause
toward the spouse who ineligibility***
needs nursing level When a spouse needs Unless age 65 or
services. HCB services, an older, person must
assessment of assets be PTD or blind, or
occurs. See Resource receives SSI or
Limits under Vendor SSDI.
Nursing Care below for Determined by the
details. Department of
Health and Senior
Services (DHSS) to
need nursing facility
level of care and be
authorized to receive
HCB waiver
services.
Chart revised on 02/20/2007 by Lee A. Waer, Turnbull Law Office, P. C.; Email Ribull@aol.com 3
Medicaid Program Summary
PROGRAM BENEFITS INCOME LIMITS RESOURCE LIMITS OTHER
REQUIREMENTS
Vendor nursing care Medicaid to A $30 personal needs $999.99 for an individual; $2,000 Transfers of property
(including ICF-MR) include direct standard, the cost of the for a married couple when both within 60 months of
payments to a person’s private medical require nursing level care. ** the application may
Medicaid insurance to include the cause ineligibility.***
certified nursing Medicare premium, and For a married couple, an To determine the
facility above when appropriate an assessment of assets occurs to number of months of
the amount the allotment to a community establish the community spouse ineligibility from the
resident is spouse or dependent are resource allowance (CSRA). The date of the transfer, the
expected to pay deducted. The remaining amount of assets protected for the amount transferred is
income or surplus community spouse is 50% of non- divided by $2,943*.
amount becomes the exempt assets subject to the Unless age 65 or older,
patient’s required $20,328* minimum and $101,640* person must be PTD or
monthly contribution to maximum. If need for income blind, or receives SSI
the nursing facility. higher than minimum monthly or SSDI.
needs allowance is established, an Determined by DHSS
The claimant’s spouse’s administrative hearing or court can to need nursing facility
income is not counted to set a higher CSRA. The hearing level of care
determine the would first look to Be in a Medicaid
institutionalized spouse’s institutionalized spouse’s income certified nursing care
monthly payment to the before setting a higher CSRA. bed for 30 days
nursing facility. The The CSRA is disregarded from the Be prescreened for
community spouse’s total non-exempt assets to mental illness, mental
income is considered determine the institutionalized retardation, and
when determining the spouse’s resource eligibility. developmental
monthly amount the disabilities.
institutionalized spouse
can send to the
community spouse.
Chart revised on 02/20/2007 by Lee A. Waer, Turnbull Law Office, P. C.; Email Ribull@aol.com 4
Medicaid Program Summary
PROGRAM BENEFITS INCOME LIMITS RESOURCE OTHER REQUIREMENTS
LIMITS
Supplemental Nursing Medicaid. SNC pays a The client’s gross $999.99 for a single Unless age 65 or older,
Care monthly cash grant, a income must be less person and $2,000 for person must be PTD, blind,
monthly $25 personal than the facility’s a married couple ** or receives SSI or SSDI.
needs allowance, and monthly basic rate. If Determined by DHSS to
the Medicare premium. the client is otherwise need nursing facility level of
The maximum grants eligible, the state care if in an ICF/SNF
are: pays the difference Be at least age 21
$156 for Residential between the facility’s
Care Facility I; $292 rate and the client’s
for RCF-II; $390 for gross income up to
non-Medicaid nursing the maximum grant.
facility (ICF/Skilled)
Blind Pension State funded Medicaid No income maximum $20,000 total Meet the state’s definition
and a $541* monthly property; The home of blindness
grant is exempt. If a Lifetime penalty period for
person leaves their transferring property to
home to enter a become eligible
nursing facility, the Cannot receive or be
homestead exemption eligible for SSI
continues. Be 18 or older
Supplemental Aid to the Medicaid and a $673 $2,000 for a single Meet the state’s definition
Blind monthly cash grant of person, $4,000 for a of blindness
$541* less any SSI married couple. ** Must apply for SSI
received Be 18 or older
Chart revised on 02/20/2007 by Lee A. Waer, Turnbull Law Office, P. C.; Email Ribull@aol.com 5
Medicaid Program Summary
PROGRAM BENEFITS INCOME RESOURCE OTHER REQUIREMENTS
LIMITS LIMITS
Qualified Medicare Pays Medicare Part B $817* for a $4,000 for a single Must receive Part A Medicare
Beneficiary premiums and in some single person; person; $6,000 for a
cases Part A. Pays co- $1,100* for a married couple **
payments and two person
deductibles for household
Medicare approved
services.
Specified Low Income Pays Medicare Part B $980* for a $4,000 for a single Must receive Part A Medicare
Medicare Beneficiary premium single person; person, $6,000 for a
$1,320* for a married couple **
couple
QI – 1 Qualifying Pays Medicare Part B $1,103* for a $4,000 for a single Must receive Part A Medicare
Individual premium single person; person; $6,000 for a Cannot receive Medicaid
$1,485 for a married couple **
couple
Medical Assistance Medicaid $2,320* $2,000 for a single Must have lost SSI due to
(Section 1619 of the person; $3,000 for a employment as determined by the
Social Security Act) married couple ** Social Security Administration
Received Medicaid in the month
immediately preceding the month
of receiving 1619 status
Qualified Disabled Pays Medicare Part A $1,634* $4,000 for a single Be under 65
Working Individual premium person; $6,000 for a Be qualified for Medicare due to a
married couple ** disability
Lost or is losing Medicare due to
employment
Must be ineligible for Medicaid
Chart revised on 02/20/2007 by Lee A. Waer, Turnbull Law Office, P. C.; Email Ribull@aol.com 6
Medicaid Program Summary
PROGRAM BENEFITS INCOME LIMITS RESOURCE OTHER REQUIREMENTS
LIMITS
Breast or Cervical Medicaid $1,634* None Be screened by a Breast and
Cancer Treatment Cervical Cancer Control Project
Medical Assistance Medicaid provider
Program Need treatment for breast or
cervical cancer
Be uninsured or have health
insurance that does not cover
breast and cervical cancer
treatment
Women must be under age 65
MC+ for Pregnant MC+ (Medicaid) 185% of the federal None Pregnancy must be verified
Women during the pregnancy poverty level (FPL)*
plus 2 months of for the household size
coverage following the including the unborn
month the pregnancy child; e. g., $2,035
ends for an expectant
mother with no
children or spouse
MC+ for newborns MC+ (Medicaid) for See other See other Child’s mother was eligible for
the child through age 1 requirements in this requirements and received Medicaid when the
row this row child was born.
Newborn remains with the mother
Medical Assistance for MC+ (Medicaid) for Temporary None Eligible child under 19 in the
Families children and their Assistance standard home
parents for the household Cooperate in obtaining medical
size; e. g., $292 for a support for the children
three-person family*
Chart revised on 02/20/2007 by Lee A. Waer, Turnbull Law Office, P. C.; Email Ribull@aol.com 7
Medicaid Program Summary
PROGRAM BENEFITS INCOME LIMITS RESOURCE OTHER REQUIREMENTS
LIMITS
MC+ for Kids MC+ (Medicaid) for children 185% of FPL* for None Child must be under age 19
only children under age 1; e. Parent cooperates in
g., $2,560 for a three- obtaining medical support
person family
133% of FPL* for ages
1 – 5; e. g., $1,840 for a
three-person family
100% of FPL* for ages
6 -18; e. g., $1,384 for
a three-person
household
If income exceeds these
limits, see next row below
MC+ for Kids MC+ (Medicaid) for children 300% of FPL* for the The family’s Children must be uninsured
(Children’s only household size; e. g., net worth must With income over 150% of
Health $4,150 for a three-person be less than FPL, children cannot have
Initiative household $250,000. access to affordable health
Program) insurance and the family
must pay a monthly
premium to the state from
$11 up to $282.
Children must be uninsured
for six months if health
insurance is dropped
without good cause.
Chart revised on 02/20/2007 by Lee A. Waer, Turnbull Law Office, P. C.; Email Ribull@aol.com 8
Medicaid Program Summary
PROGRAM BENEFITS INCOME RESOURCE OTHER REQUIREMENTS
LIMITS LIMITS
Transitional MC+ (Medicaid) coverage for 185% of the None Received Medical Assistance for
Medical the family for up to one year FPL* for the Families in 3 of the last 6 months
Assistance second 6 months preceding ineligibility
Became ineligible due to
employment, increased wages, or
loss of earned income disregards
Return quarterly reports
Have a child under 19 in the home
Medical MC+ (Medicaid) for the family None None Received Medical Assistance for
Assistance for for 4 months Families in 3 of the last 6 months
Child Support preceding ineligibility
Closings Became ineligible due to the receipt
of or increased income from child
support or alimony
Extended Provides coverage for family None None Received MC+ coverage due to
Women’s Health planning, and testing and pregnancy
Services treatment of sexually transmitted Be uninsured
diseases for women who lose
MC+ coverage two months after
the pregnancy ends. Coverage
is limited to 12 months.
Chart revised on 02/20/2007 by Lee A. Waer, Turnbull Law Office, P. C.; Email Ribull@aol.com 9
Medicaid Program Summary
PROGRAMS BENEFITS INCOME RESOURCE OTHER REQUIREMENTS
LIMITS LIMITS
Refugee Medicaid for 8 months None None Do not meet eligibility guidelines in
Assistance any of the above programs e. g.,
Medical Assistance or Medical
Assistance for Families
Must meet a certain alien status
Temporary Medicaid covered ambulatory 185% FPL None Determined eligible by a qualified
Medicaid During prenatal care services through a provider such as a participating health
Pregnancy Medicaid provider. Coverage department
(TEMP) ends the last day of the month
following the month the
expectant mother was
determined presumptive eligible.
Presumptive Medicaid coverage ends the 150% FPL None Child has not received presumptive
Eligibility for month following the month of eligibility within the last 12 months.
Children application. Determined eligible by a qualified
entity such as a participating
children’s hospitals
Medical Medicaid coverage for See Other See Other Individual does not meet the
Assistance for emergency care only Requirements in Requirements definition of a qualified alien.
Ineligible Aliens this row in this row Individual must meet all of the
guidelines for a program e. g.,
Medical Assistance or Medical
Assistance for Families except for
the citizenship or qualified alien
status.
Chart revised on 02/20/2007 by Lee A. Waer, Turnbull Law Office, P. C.; Email Ribull@aol.com 10
Medicaid Program Summary
*COST OF LIVING ADJUSTMENTS:
Amounts are effective as of January 16, 2007. Amounts are subject to periodic adjustments e. g., programs based on the FPL are
adjusted annually. Some program amounts are set by appropriations each year by the legislature e.g., the Medical Assistance (non-
vendor) program for persons who are at least age 65 or who are permanently and totally disabled.
The Medical Assistance for Families program uses the Temporary Assistance program’s maximum monthly grant amounts for the
income guidelines. The payment amounts are set by appropriation. The following chart provides the maximums for families from one
to six persons for fiscal year ending June 30, 2007:
Number of Person Maximum Payment
1 $136
2 $234
3 $292
4 $342
5 $388
6 $431
** RESOURCE LIMITS:
Resources include but are not limited to checking accounts, savings accounts, certificates of deposit, Individual Retirement Accounts,
promissory notes, cash value of life insurance policies above a $1,500 exemption, recreational vehicles, and a second home.
A person’s car is not a resource that is being used to go to work, get medical care, and used for other transportation needs. Any
additional vehicles may be considered to be a resource.
A person’s place of residence, the adjoining land, and the home’s furnishings are exempt. The homestead exemption continues if a
person leaves his or her home to enter a RCF-II, ICF, skilled nursing facility or Medicaid certified bed, or if a spouse resides in the
home. If none of these exemptions occur, the home becomes a resource in 24 months from the time the person leaves the home to
reside in senior citizen housing, live with a relative, or be in some other living arrangement. This 24 month rule does not apply to
Chart revised on 02/20/2007 by Lee A. Waer, Turnbull Law Office, P. C.; Email Ribull@aol.com 11
Medicaid Program Summary
QWDI, QMB, SLMB and QI-1 claimants who express the intent to return to their home. Claimants who have more than $500,000 in
home equity are not eligible for Medicaid vendor nursing care or HCB.
***TRANSFER OF PROPERTY
The Deficit Reduction Act of 2005 enacted a number of changes for nursing care applications for transfers that occur on or after
February 8, 2006:
1. Made the look back period 60 months;
2. Requires the transfer penalty period to begin in the month of application if the client is otherwise eligible except for the
transfer;
3. Requires the states to total multiple transfers within 60 months of the application to determine the amount transferred;
4. Imposes days of ineligibility for transfer amounts which are less than the state’s penalty transfer divisor determined by
dividing the remainder by $96.75.
Transfers that occurred before February 8, 2005:
1. Are subject to a 36 month look back period (60 months for trust transfers);
2. Begin the penalty in the month of the transfer;
3. A separate penalty is established for each monthly transfer rather than accumulating them;
4. No transfer penalty is imposed when the quotient is less than .50 after dividing the amount transferred by the state’s transfer
divisor amount. The amount is then rounded down or up to the nearest whole number.
APPLICATION REQUIREMENTS:
Persons must verify their Social Security Numbers, be living in the State of Missouri, and be a U. S. citizen or eligible legal
immigrant. There are additional eligibility requirements in some of the above listed programs. Medicaid claimants must provide
documentary evidence of citizenship and identity.
Chart revised on 02/20/2007 by Lee A. Waer, Turnbull Law Office, P. C.; Email Ribull@aol.com 12
Medicaid Program Summary
MANAGED CARE:
Claimants in family based programs such as MAF and MC+ receive their health care coverage through a managed care plan in some
counties.
PROGRAMS OTHER THAN MEDICAID IN FSD:
FSD also has a Rehabilitation Services for Blind unit that assists the visually impaired. FSD also administers the Food Stamp,
Temporary Assistance, and Low Income Home Energy Assistance programs.
PROGRAMS OFFERED BY OTHER AGENCIES:
Other assistance may be available through different state agencies:
The Department of Social Services, Children’s Division, has such programs as foster and alternative care. DSS administers the
Missouri RX Plan which coordinates prescription drug coverage with the Medicare Part D program.
The Department of Mental Health has programs that provide long-term care in the community and in facilities for persons with
developmental disabilities, mental retardation, and mental illness.
The Department of Health and Senior Services administers such programs as the Missouri Senior Rx program to help the elderly
obtain prescription medications and the home and community based services that provide personal care, homemaker/chore help,
nursing services, counseling, respite care, and case management.
The Missouri Division of Vocational Rehabilitation operates an independent living waiver that provides self-directed home and
community based services for disabled persons ages 18 – 64. The Personal Care Assistance program will be moved to DHSS.
The Missouri Kidney Program through the University of Missouri at Columbia helps eligible patients with kidney diseases obtain
medical care.
A good source of finding services and programs for disabled persons throughout the state is the Governor’s Council on Disability or
Phone: 573-751-2600, Information Hotline 1-800-877-8249, Fax: 573-526-4109, http://www.gcd.oa.mo.gov/index.shtml.
Chart revised on 02/20/2007 by Lee A. Waer, Turnbull Law Office, P. C.; Email Ribull@aol.com 13
