Missouri to Implement Medicaid Expansion

In accordance with the Cole County Circuit Court's August 10 ruling, the Missouri Department of Social Services (DSS) will begin allowing individuals to apply for the MO HealthNet program under Article IV, Section 36(c) of the Missouri Constitution.

"My administration is always going to follow the law and yesterday's court order is no exception," Governor Mike Parson said. "The necessary funding to cover the health care costs of the expanded population remains the issue. We will continue to work with the General Assembly and DSS to chart a path forward to comply with the court order and keep the MO HealthNet program solvent." 

Missouri voters approved Medicaid expansion, the Supreme Court of Missouri held the expansion amendment to be constitutional, and the trial court has ordered the state not to prohibit enrollment. The expansion amendment also legally requires the state to maximize federal funding. DSS will continue to work towards fulfilling the state's legal obligations under the Constitution and court order. 

The state is currently working through administrative hurdles, including adequate appropriations, staffing capacity, and computer software changes in order to begin enrolling the expanded population. Governor Parson included funding in his FY 22-23 budget proposal to the General Assembly to cover both the health care costs of the expanded population and for 75 additional employees to administer the expanded program.

The proposed funds were not included in the final FY 21-22 budget. As a result, DSS is limited to administering the expanded MO HealthNet program without sufficient staffing or appropriations. 

Missourians who believe they are eligible for MO HealthNet benefits under the expanded Medicaid eligibility may go to MyDSS.MO.Gov to apply. DSS will begin making eligibility determinations once MO HealthNet's software is updated to reflect the court order. In order to comply with the court order and until the necessary funds can be appropriated, DSS will reassign existing employees from their current assignments and responsibilities in order to receive and evaluate MO HealthNet applications.

Due to current staffing capacity and funding restraints, the required system update is anticipated to take up to 60 days. Qualifying health care costs that are incurred by eligible Missourians between the time they apply and when DSS is able to verify their eligibility may be reimbursed at a later date. 

Benefits of Missouri RX Program

The Federal Government has been touting the prescription drug benefits of the Affordable Healthcare Act. However, the Missouri RX plan covers much of peoples’ prescription drug costs if they are enrolled in Medicare Part D. The following are the benefits of the MoRx program as listed on the Missouri Department of Social Services website:

–MoRx works with all Medicare Part D plans.

–MoRx pays for 50% of your out-of-pocket costs on medications that are covered by your Medicare Part D plan. This means you will save 50% on your deductible, 50% on your co-pays, including during the coverage gap and beyond. MoRx does not pay for the Medicare Part D plan's monthly premium.

–MoRx uses the formulary of the Medicare Part D plan. Any drug covered by a member's Medicare Drug Plan will also be covered by MoRx.

–Dual eligible members will continue to have coverage for Medicare-excluded drugs through MO HealthNet. Medicare-excluded drugs include specific over-the-counter drugs, vitamins, minerals, limited cough and cold drugs, benzodiazepines and barbiturates.

–MoRx covers up to a 31-day supply for each prescription.

–You can use any Missouri pharmacy that works with your Part D plan. (MoRx does not cover mail order services)

For additional information about the MoRx Plan, contact the MoRx Plan Helpdesk toll-free at 1-800-375-1406. For questions about enrolling in Medicare Part D, call 1-800-MEDICARE (1-800-633-4227) or visit the Medicare Web site at www.medicare.gov. For questions about how MO HealthNet and Medicare Part D will work together, contact the Participant Services Unit toll-free at 1-800-392-2161.