Medicaid for nursing home and home care in Missouri

Three kinds of help

• Nursing home coverage (vendor care): MO HealthNet pays the nursing home for your room, board and needed care, after your own income is applied.
• Home and Community Based Services (HCBS): In-home help such as personal care, homemaker help, home-delivered meals and respite, for people who would otherwise need a nursing home.
• Supplemental Nursing Care (SNC): A monthly cash payment if you live in a residential care or assisted living facility and your income does not cover the cost.

Who qualifies

You must:

• Be 65 or older, blind, or permanently disabled.
• Live in Missouri and be a U.S. citizen or qualified non-citizen.
• Be approved by DHSS for nursing facility care, or for in-home services.
• Qualify for MO HealthNet, with income and assets within the limits.

The income rules

In a nursing home

Missouri does not use a strict income cap for nursing home care. Instead, you use all of your income toward the nursing home's cost, except:

• $50 a month for personal needs,
• what you pay for health insurance premiums, and
• income set aside for a spouse or dependents at home.

MO HealthNet pays the rest of the nursing home's Medicaid rate.

At home with HCBS

To get home care through MO HealthNet, your income can be up to $1,737 a month (counting only your own income). If DHSS approves you for in-home services, you do not have to meet a spenddown.

Regular MO HealthNet and spenddown

If you do not need long-term care, the MO HealthNet income limit for older adults is $1,131 a month for one person. If your income is higher, you may still qualify with a spenddown, where you cover part of your medical bills each month before MO HealthNet pays.

What counts as assets

Countable assets include cash, bank accounts, and other property you could turn into cash. The limit is $6,220.50 for one person or $12,441 for a couple.

• Your home: You may not qualify for long-term care if your home equity is over $752,000. Ask FSD how your home is treated.
• Trusts: FSD has checklists for trusts at mydss.mo.gov/legal-trust. Talk with a lawyer before setting one up.
• Gifts and transfers: Giving away assets, or selling them for less than they are worth, can delay coverage for long-term care.

If your spouse lives at home

Missouri follows federal rules to keep the spouse at home from being left without money:

• Assets: Your spouse can keep a share of your combined assets, between $32,532 and $162,660.
• Income: Your spouse may get a monthly allowance from your income, so their total income reaches at least $2,705, up to $4,066.50.

FSD explains these rules on its spousal impoverishment page, mydss.mo.gov/spousi.

Home and community services

• Aged and Disabled Waiver: For people 65 and over, or 63 and 64 if disabled, who need nursing home level of care. It pays for homemaker and chore help, home-delivered meals, respite for caregivers, and adult day care.
• Structured Family Caregiving Waiver: For adults with Alzheimer's or a related condition who live with a paid family caregiver.
• State plan in-home services: MO HealthNet members approved by DHSS can get personal care, home health and house cleaning help.
• PACE: For people 55 and over who need nursing home level care but can live safely at home. Offered in parts of St. Louis City and County, all of Jackson, Greene, Christian and Webster counties, and parts of some nearby southwest Missouri counties. Ask at [email protected].

Supplemental Nursing Care

If you are 21 or older and live in a licensed residential care facility, assisted living facility, or some nursing facilities, and your income is less than the facility's cost, SNC pays the difference up to a cap:

• Up to $156 a month in a residential care facility.
• Up to $292 a month in assisted living.
• Up to $390 a month in certain nursing facilities.
• Plus a $50 monthly personal needs allowance.

How to apply

1. Get a care assessment. For home care, call DHSS at 877-304-7939 to ask for an assessment or make a referral. For a nursing home, DHSS must approve your need for nursing facility care.
2. Apply for MO HealthNet. Apply online at dss.mo.gov/healthcare/apply, at an FSD Resource Center (find one at dss.mo.gov/dss_map), or call 855-373-4636 to get a paper application by mail. On the application, check the box that someone lives in a medical facility or nursing home.
3. Already on MO HealthNet? Report the move into a nursing home with the online Change Report, at an FSD Resource Center, or by calling 855-FSD-INFO (855-373-4636). Tell the nursing home you have MO HealthNet so it can report your admission. For SNC, send the MO HealthNet Application Addendum (form IM-1MAC) and check the SNC box.
4. Send papers through the upload portal at mydssupload.mo.gov, or mail them to Family Support Division, P.O. Box 2700, Jefferson City, MO 65102.
5. Someone helping you? A family member can be named with the Appoint an Authorized Representative form (IM-6AR).
6. Wait for a decision. FSD says decisions take 45 to 90 days.

After you apply

• Renewals: MO HealthNet coverage is renewed every year. Keep your mailing address current with FSD and return renewal forms on time. Renewal information is at mydss.mo.gov/renew.
• Report changes in income, assets or where you live to FSD with the Change Report.
• Appeals: If FSD denies, changes or stops your coverage and you think it is wrong, you can ask for a hearing by calling 855-FSD-INFO (855-373-4636) or in person at a Resource Center. Your notice gives the deadline, so act quickly. The hearing notice is mailed at least 10 days before the hearing, and the decision comes in writing.
• Estate recovery: After a member 55 or older dies, MO HealthNet may seek repayment from the estate. It does not do this while a spouse, a child under 21, or a blind or disabled child survives. A lien may be placed on the property of nursing home residents 55 and over. Questions: Cost Recovery Unit, 573-751-2005.

Things people miss

• HCBS can mean no spenddown. If DHSS approves you for in-home services, the spenddown rule does not apply.
• Assisted living residents can get SNC even though it is not a nursing home.

Free help

• DHSS home and community services: 877-304-7939.
• Senior Resource Line: 1-800-235-5503, to reach your Area Agency on Aging.
• Missouri SHIP: 1-800-390-3330, free help with Medicare and how it works with MO HealthNet.

See also paying for a nursing home, Medicare, and all benefits in Missouri.

Phone numbers: Free help lines for Missouri agencies

Check what you may qualify for