State Government Insurance Programs Offered

Missouri Health Insurance Pool (MHIP) www.mhip.org

800-821-2231

Hospital, physician care, maternity, prescription drugs, some limitations on alcohol and drug abuse care. For most services, plan will pay for 80% of covered charges after you satisfy your annual deductible if you receive care in-network. After paying maximum amount of coinsurance charges for covered in-network services, MHIP will pay 100% of your covered charges for the rest of the calendar year. MHIP: Must be a Missouri resident with a qualifying health condition and show proof of one of the following: 1) Rejection for health coverage by an insurers for pre-existing condition; 2) Offer of coverage similar to but at rates higher than MHIP’s coverage; 3) Involuntary loss of coverage for a reason other than non-payment of premium or fraud; 4) Being a dependent of a person eligible for MHIP; 4) Eligibilty for HIPAA or Trade Adjustment Assistance. PCIP: Must be a Missouri resident, be uninsured for at least six months, and show proof of the following: 1) Lawful presence in the United States; 2) Having a pre-existing health condition.

MO Healthnet (Medicaid)

888-275-5908 573-731-3425

www.dss.mo.gov/mhd Inpatient and outpatient hospital care, Laboratory and x-rays, Physician’s services, Emergency ambulance, Audiology, Podiatry, Ambulatory surgical services, Durable medical equipment, Prosthetics and orthotics, Vision care, Family planning, Rehabilitative services and therapies, Midwife services, Federally qualified health centers or rural health clinics, Psychiatry, Transplants, Home and community based services, Waivers to person 65 and older, Persons with AIDS, or developmentally disabled individuals, Early and periodic screening, diagnosis and treatment (EPSDT) for children under 21 years old. Pre-Existing Health Conditions Covered Must be U.S. citizen or an eligible qualified non-citizen living in Missouri. Income limits: Infants ages 0–1: 185% FPL. Children ages 1–5: 133% FPL. Children ages 6 –18: 100% FPL. Parents/caretakers living with children ages 0–18: 25% FPL. Pregnant women: 185% FPL. Aged, blind, and disabled: 85% FPL with asset limit of $1,000 for singles and $2,000 for couples. Limited assets such as cash, savings, stocks and bonds.

Children and Youth with Special Health Care Needs Program (CYSHCN)

573-751-6246 800-451-0669

Children and Youth with Special Health Care Needs Program (CYSHCN) health.mo.gov Search: (Children Special Health Care Needs) Limited coverage includes Tests and evaluations, Inpatient care, Surgery, Therapy (physical, occupational, speech, language), Prescription medicines, Equipment, and supplies. Covered conditions include but are not limited to arthritis, Burns, Cerebral palsy, Cleft lip and palate, Cystic fibrosis, Digestive disorders, Ear infections (chronic), Hearing disorders, Heart disorders, Hemophilia, Hydrocephalus, Neuromuscular disorders, Orthopedic disorders, Paraplegia, Quadriplegia, Seizures, Sickle cell disease, Spina bifida, Spinal cord deformities, Traumatic brain injury, Urinary disorders. CYSHCN is payer of last resort. The program‘s service coordinator will assist the participant/family with resource identification and referral. All third party liability must be exhausted prior to accessing CYSHCN funds. Must be age 0–21, and reside in Missouri, with income limit of 185% FPL and a eligible special health care need.

MO HealthNet for Kids (MHK)

888-275-5908

www.dss.mo.gov (Search: MHK) Comprehensive care including but not limited to doctor visits, mental, dental, prescriptions, hospitalization and more. Must be a U.S. citizen or an eligible qualified non-citizen living in Missouri. Income limits: Infants age 0–1: 185% FPL. Children ages 1–5: 133% FPL. Children ages 6–18: 100% FPL. Children ages 0–18 with no prior health insurance in the last 6 months: 300 % FPL.

Women-Infant- Children (WIC)

573-751-6204 800-392-8209

www.dhss.mo.gov/wic Nutrition education and services, breastfeeding promotion and education, monthly food prescription of nutritious foods, and access to maternal, prenatal and pediatric health-care services. Pregnant women, non-breastfeeding postpartum women (up to 6 months after delivery or termination of the pregnancy), breastfeeding women (up to 1 year after delivery as long as they are breastfeeding the baby), children age 0 to 5, and individually determined to be at “nutritional risk” by a health professional. Income must be at or below 185% FPL and live in Missouri.

Show Me Healthy Women

573-522-2845

Offers screenings for breast and cervical cancer. Pelvic exams, Pap tests, clinical breast examinations (CBE), diagnostic breast and cervical exams, and mammograms. Must be U.S. citizens or legal permanent residents and live in Missouri. Income limit of 200% FPL. Must be women ages 50–64, or older without Medicare Part B. Women ages 35–49 are eligible for pelvic exams, Pap tests, clinical breast examinations (CBE), diagnostic breast services if CBE results are suspicious for cancer, and diagnostic cervical services if their initial/follow-up Pap test was abnormal. Women ages 50 and older get all benefits above plus mammograms. Cervical cancer screenings are offered to women who have had a hysterectomies. Treatment is available for U.S. citizens diagnosed with cancer through the Show Me Healthy Women program. Women with MO HealthNet, Medicare Part B or HMO health coverage are not eligible. WISEWoman: Must participa

WISe Woman

573-522-2845

www.dhss.mo.gov/WISEWOMAN Offers health screenings and lifestyle education that can reduce the risk of heart disease and stroke. Must participate in the Show Me Healthy Women breast and cervical cancer control project and be 35–64 years old

Medicare www.medicare.gov

800-633-4227

Medicare offers Part A, inpatient care in hospitals and rehabilitative centers; Part B, doctor and some preventive services and outpatient care; Part C allows Medicare benefits through private insurance (Medicare Advantage); Part C includes Parts A, B, and C not covered by Medicare. Part D covers prescription drugs. Senior Rx is a prescription discount program. Medicare: Must be U.S. citizen or permanent U.S. resident, and: 1) If 65 years or older, you or your spouse worked for at least 10 years in Medicare-covered employment, or 2) You have a disability or end-stage renal disease (permanent kidney failure requiring dialysis or transplant) at any age. Senior Rx: To qualify for Senior RX you must have Medicare Part D. If you are single your income must be at or below $21,660 and if you are a married your income must be below $29,140

VA Medical Benefits Package

877-222-8387

www.va.gov Comprehensive preventive and primary care, outpatient and inpatient services. ”Veteran status” = active duty in the U.S. military, naval, or air service and a discharge or release from active military service under other than dishonorable conditions. Certain veterans must have completed 24 continuous months of service.