Summary
Medicaid’s rules, benefits and name can all vary by state. In Missouri, Medicaid is called MO HealthNet. This article focuses on Missouri Medicaid Long Term Care for seniors, which will pay for care in a nursing home, a beneficiary’s home and other settings through one of three programs – Nursing Home Medicaid, HCBS Waivers and ABD Medicaid. This is different than regular Medicaid, which is for financially limited people of all ages.
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. Coverage includes payment for room and board, as well as all necessary medical and non-medical goods and services, such as:
Items not covered include a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example) and any care services not considered medically necessary.
Missouri Nursing Home Medicaid beneficiaries are required to give most of their income to the state to help cover nursing home costs. They are allowed to keep a “personal needs allowance” (PNA) of $50/month, which can be spent on personal items such as clothes, snacks, books, haircuts, flowers, etc. They can also keep enough of their income to make Medicare premium payments if they are “dual eligible,” and enough to make any Medicaid-approved spousal income allowance payments to financially needy spouses who are not Medicaid applicants or recipients.
Missouri Nursing Home Medicaid is an entitlement. This means all qualified applicants are guaranteed by law, aka “entitled,” to receive benefits without wait. However, not all nursing homes accept Medicaid, and those that do may not have any available spaces when you or your loved one needs care. So, eligible applicants are guaranteed nursing home coverage without wait, but they are not guaranteed coverage in any facility they choose.
A Nursing Home Alternative – Nursing Home Medicaid beneficiaries in Missouri who want to leave their nursing home and return to living “in the community” can receive financial and functional help with that transition through the Money Follows the Person program (MFP). This help can include paying for moving expenses, as well as long-term care services and supports in the new residence. MFP beneficiaries must be moving from a Medicaid-approved facility and into their own home, the home of a relative or a small group home with a maximum of four unrelated residents.
Missouri Home and Community Based Service (HCBS) Waivers will pay for long-term care services and supports that help financially limited Missouri seniors who require a Nursing Facility Level of Care remain living in the community instead of moving to a nursing home. The word “waiver” means something like voucher in this instance. Think of it as a voucher that will pay for long-term care services for Missouri residents who live in their own home or the home of a loved one. While Missouri HCBS Waivers can pay for long-term care benefits in those settings, they will not pay for room and board costs such as mortgage payments, rent, utility bills or food expenses.
The HCBS Waivers in Missouri relevant to seniors are the Aged and Disabled Waiver and the Structured Family Caregiving Waiver.
1. Aged and Disabled Waiver
Missouri’s Aged and Disabled Waiver (ADW) provides long-term care services and supports to eligible Missouri seniors who are age 65 and older. Physically disabled Missouri residents 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. The ADW is meant to support unpaid caregivers, who are often family members.
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. Missouri seniors interested in applying for the ADW should contact their local family support office for a referral.
Unlike Nursing Home Medicaid, the ADW is not an entitlement. Instead, it has a limited number of enrollment spots (about 27,000 per year as of 2022). Once those spots are full, additional applicants will be placed on a waitlist.
2. Structured Family Caregiving Waiver
Missouri’s Structured Family Caregiving Waiver (SFCW) provides long-term care services and supports to eligible Missouri seniors with Alzheimer’s disease or related dementias who live in a private residence with an unpaid caregiver. The caregiver 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 SCFW beneficiary must live in the same residence. The caregiver can be compensated for providing long-term care services and supports such as medication management, housekeeping, transportation and assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting).
The SCFW is not an entitlement. Instead, it has a maximum of 300 enrollment spots per year (as of 2022). Once those spots are full, additional eligible applicants will be placed on a waitlist.
Missouri’s Aged, Blind, and Disabled (ABD) Medicaid provides healthcare and long-term care services and supports to financially limited Missouri residents who are aged (age 65+), blind or disabled. ABD Medicaid can sometimes be referred to as regular Medicaid for seniors, but it should not be confused with the regular Medicaid that is available for low-income people of all ages. ABD Medicaid is an entitlement, which means that anyone who meets the requirements is guaranteed by law to receive healthcare coverage without wait. Access to long-term care benefits via ABD Medicaid depends on the availability of funds, programs and caregivers in the area where the beneficiary lives.
Missouri ABD Medicaid applicants and recipients who show a medical need for long-term care benefits can receive those benefits through four programs:
1. Home and Community Based Services
Missouri’s Home and Community Based Services program provides long-term care benefits to Missouri ABD Medicaid beneficiaries who live in their own home or the home of a loved one and require a Nursing Facility Level of Care.
Home and Community Based Services program 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). These benefits will be made available depending on the functional needs and circumstances of each individual.
2. Consumer Directed Services
Missouri’s Consumer Directed Services (CDS) Program allows Missouri 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 self-direct their care by hiring personal care providers of their choice, including family members. These caregivers will be paid by the state to provide necessary long-term care services, including meal preparation, housekeeping, transportation, medication management and personal care assistance with the Activities of Daily Living (mobility, dressing, bathing, eating, toileting).
3. Supplemental Nursing Care Assistance
Missouri’s Supplemental Nursing Care (SNC) Assistance program provides cash assistance to Missouri 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.
As of 2022, the Supplemental Nursing Care (SNC) Assistance program will pay up to $156/month for individuals living in a residential care facility Level I, and up to $292/month for beneficiaries living in a residential care facility Level II or an assisted living facility. Program participants also receive a $50/month personal needs allowance.
The Supplemental Nursing Care (SNC) Assistance program is an entitlement, so the state does not limit the number of participants. However, there may be waitlists for individual facilities if they do not have the space to accept to new residents.
4. Program of All-Inclusive Care for the Elderly (PACE)
Missouri residents who are age 55 or older and have ABD Medicaid can cover their medical, social service and non-medical personal needs with one comprehensive plan and delivery system using the Program of All-Inclusive Care for the Elderly (PACE). PACE program participants are required to need a Nursing Facility Level of Care, but they must live in the community. Missouri’s PACE program can be used by people who are “dual eligible” for Medicaid and Medicare, and it will coordinate the care and benefits from those two programs into one plan. PACE also administers vision and dental care, and PACE day centers provide meals, social activities, exercise programs and regular health checkups and services to program participants. The Missouri PACE program is called New Horizons PACE and it’s located in St. Louis. To learn more about PACE, click here.
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 Medicaid, Home and Community Based Services (HCBS) Waivers or Aged, Blind, and Disabled (ABD) Medicaid.
Just For You: The easiest way to find the most current Missouri Medicaid eligibility criteria for your specific situation is to use our Medicaid Eligibility Requirements Finder tool.
Financial Requirements
Missouri residents have to meet an asset limit in order to be financially eligible for nursing home coverage through MO HealthNet (Missouri Medicaid). The asset limit for a single applicant from July 2024 to June 2025 is $5,909.25, which means they must have $5,909.25 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 How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.
The asset limit for married couples with both spouses applying is a combined $11,818.45 from July 2024 to June 2025. For a married applicant with just one spouse applying, the asset limit is $5,909.25 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance.
There is no income limit for Missouri Nursing Home Medicaid. However, Missouri Nursing Home Medicaid recipients are required to give almost all of their income to the state to help cover the cost of care. They are only allowed to keep $50/month of their income as a “personal needs allowance,” plus enough to make Medicare premium payments if they are “dual eligible,” and they can make any allowable spousal income allowance payments to financially needy spouses who are not covered by or applying for Medicaid.
Plan Ahead: There are alternative pathways to eligibility for Missouri Nursing Home Medicaid applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply 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 Nursing Home Medicaid 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 is normally associated with a nursing home. To determine if the NFLOC requirement is met for Medicaid purposes, Missouri uses the interRAI Home Care assessment tool to evaluate the applicant’s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (these include shopping, cooking, housekeeping and medication management).
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). The asset limit for a single ADW applicant is $5,909.25 from July 2024 to June 2025, which means they must have $5,909.25 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 How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.
The 2024 income limit for a single ADW applicant is $1,649/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 asset limit for the ADW is a combined $11,818.45 (from July 2024 to June 2025), and the income limit is $1,649/month per spouse. For a married applicant with just one spouse applying for the ADW, the asset limit is $5,909.25 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The income limit is $1,649/month for the applicant spouse and the income of the non-applicant spouse is not counted.
For the Structured Family Caregiving Waiver (SFCW), the income limit for a single applicant from April 2024 to March 2025 is $1,067/month, and the asset limit is $5,909.25 (as of July 1, 2024). For married applicants with both spouse applying for the SFCW from April 2024 to March 2025, the income limit is $1,067/month per spouse, and the asset limit is $11,818.45 (as of July 1, 2024). For married applicants with one spouse applying, the asset limit is $5,909.25 for the applicant spouse and $154,140 for the non-applicant spouse. The income limit is $1,067/month for the applicant spouse and the income of the non-applicant spouse is not counted.
Plan Ahead: There are alternative pathways to eligibility for Missouri HCBS Waiver applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply 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 Services (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 is normally associated with a nursing home. To determine if the NFLOC requirement is met for Medicaid purposes, Missouri uses the interRAI Home Care assessment tool to evaluate the applicant’s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (these include shopping, cooking, housekeeping and medication management).
Financial Requirements
Missouri residents have to meet an asset limit and an income limit in order to be financially eligible for Missouri Aged, Blind, and Disabled (ABD) Medicaid. The asset limit for a single applicant from July 2024 to June 2025 is $5,909.25, which means they must have $5,909.25 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 How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.
The income limit for Missouri ABD Medicaid for a single aged (65 and over) applicant from April 2024 to March 2025 is $1,067/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 asset limit for Missouri ABD Medicaid as of July 1, 2024 is a combined $11,818.45, and the income limit from April 2024 to March 2025 is a combined $1,448/month. These limits apply to married couples with both spouses applying and married couples with just one spouse applying.
Plan Ahead: There are alternative pathways to eligibility for Missouri ABD Medicaid applicants who are over the asset limit and/or the income limit, such as Medicaid Planning. While Missouri has a Look-Back Period of five years for Nursing Home Medicaid and Home and Community Based Services Waivers applicants to make sure they don’t give away their assets to get under the limit, there is no Look-Back Period for ABD Medicaid applicants. However, ABD applicants should be cautious about giving away their assets. They might eventually need Nursing Home Medicaid, or an HCBS Waiver, and those programs will deny or penalize the applicant for giving away assets.
Functional Requirements
The only functional requirement to receive basic healthcare coverage through Missouri ABD Medicaid is being aged (65 and over), blind or disabled. For ABD Medicaid applicants and beneficiaries who require long-term care services and supports, the state will administer an assessment of their ability to perform Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and Instrumental Activities of Daily Living (which include shopping, cooking, housekeeping and medication management) to determine the kind of long-term care benefits the state will cover.
One’s home is often their most valuable asset, and if counted toward Medicaid’s asset limit, it would likely cause them to be over the limit. However, in many situations the home is not counted against the asset limit:
These rules apply to all three types of Medicaid, with one important exception – ABD Medicaid applicants can disregard the home equity limit. Value does not matter regarding their home’s exempt status. To learn more about the impact of home ownership on Medicaid eligibility, click here.
Missouri Medicaid Long Term Care applicants and recipients may also want to consider protecting their home (and other assets) from estate recovery. States are required by law to try and collect reimbursement for long-term care after the death of Medicaid recipients. They do this through their Medicaid Estate Recovery Programs (MERPs). The rules and regulations regarding estate recovery can vary greatly by state, but all states have a MERP. To learn more about the MERP in Missouri and how you can protect your home from it, click here.
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 Services (HCBS) Waivers or Aged, Blind, and Disabled (ABD) 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 may include tax forms, Social Security benefits letters, deeds to the home, proof of life insurance and quarterly statements for all bank accounts, retirement accounts and investments. For a complete list of documents you might need to submit with your Medicaid Long Term Care application, go to our Medicaid Application Documents Checklist.
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.
For step-by-step guides to applying for each of the three types of Medicaid Long Term Care, just click on the name: 1) Nursing Home Medicaid 2) HCBS Waivers 3) ABD Medicaid.
Professional Help: Many seniors need support when it comes to Medicaid Long Term Care’s rules, benefits and application process. These are all complicated, constantly changing and vary by state. The best place to get help with Medicaid Long Term Care is through a professional like a Certified Medicaid Planner or an Elder Law Attorney.
After being approved for nursing home coverage through MO HealthNet (Missouri Medicaid), seniors have to choose the Medicaid-accepting nursing home that best fits their needs. Even though Medicaid nursing home coverage is an entitlement, not all nursing homes accept Medicaid, and those that do may not have available spaces. Finding the right facility can be tricky, especially if you’re looking in a specific area.
Missouri has roughly 500 nursing homes, and they’re spread throughout the state with clusters around the bigger cities. There are about 100 nursing homes within 25 miles of St. Louis that accept MO HealthNet, which includes the suburbs out to Chesterfield and St. Peters. Kansas City has around 50 nursing homes on the Missouri side. There are nearly 30 nursing homes in the Springfield area, and there are 24 facilities between Columbia and Jefferson City.
Residents in some Missouri communities may regularly cross the state border for personal and business reasons, including healthcare. But Medicaid coverage does not cross state lines. So, someone with MO HealthNet will not be covered for nursing homes in Kansas City, Kansas, or Alton, Illinois, even if facilities in those areas are more convenient or well-suited for the Missouri resident.
TOOLS: To find and compare nursing homes, Missouri residents can use Nursing Home Compare, which is a search tool administered by the Centers for Medicare & Medicaid Services (CMS) that has information on more than 15,000 nursing homes across the country. They can also use this state government directory of Missouri nursing homes.
When you’ve found nursing homes in your area that accept Medicaid, you can start comparing them, if you have multiple options. The search on Nursing Home Compare can be filtered by staffing, health inspections, quality measures and overall rating, which can be a good place to start. The healthcare professionals who work with you can also be a great source of information. And you can also contact your local Area Agency on Aging to find out more information about nursing homes in Missouri.
After doing some research, you or someone you trust should visit any nursing homes you’re considering before making a final decision. Call first to make an appointment for the visit, and arrive with a list of questions, like: Does the residence offer social activities? How does it help residents with vision and dental care? Who are the staff doctors? What is the food like? CMS has a comprehensive “Nursing home checklist” you can use to evaluate a nursing home while visiting.
CMS data shows that nursing homes in Missouri are slightly below the national average when it comes to health conditions and fire safety. Missouri nursing homes averaged 30.1 health deficiencies that led to citation during a three-year period from 2019-2022, while the national average was 25.7. As for fire safety deficiencies, Missouri nursing homes averaged 21.1 compared to the national average of 13.5. This doesn’t mean all Missouri nursing homes have heath or fire safety issues, but some of them certainly do, so you should do your research in these areas before making any final decisions.
If you need Medicaid long term care but do not meet the financial eligibility criteria, consider working with a Medicaid Planning professional. These fee-based experts help families structure their finances to become eligible, while streamlining the application process and preserving assets for spouses and family members.
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