208.151. Medical assistance, persons eligible--rulemaking authority.
Medical assistance, persons eligible--rulemaking authority.
208.151. 1. Medical assistance on behalf of needy persons shall beknown as "MO HealthNet". For the purpose of paying MO HealthNet benefitsand to comply with Title XIX, Public Law 89-97, 1965 amendments to thefederal Social Security Act (42 U.S.C. Section 301, et seq.) as amended,the following needy persons shall be eligible to receive MO HealthNetbenefits to the extent and in the manner hereinafter provided:
(1) All participants receiving state supplemental payments for theaged, blind and disabled;
(2) All participants receiving aid to families with dependentchildren benefits, including all persons under nineteen years of age whowould be classified as dependent children except for the requirements ofsubdivision (1) of subsection 1 of section 208.040. Participants eligibleunder this subdivision who are participating in drug court, as defined insection 478.001, RSMo, shall have their eligibility automatically extendedsixty days from the time their dependent child is removed from the custodyof the participant, subject to approval of the Centers for Medicare andMedicaid Services;
(3) All participants receiving blind pension benefits;
(4) All persons who would be determined to be eligible for old ageassistance benefits, permanent and total disability benefits, or aid to theblind benefits under the eligibility standards in effect December 31, 1973,or less restrictive standards as established by rule of the family supportdivision, who are sixty-five years of age or over and are patients in stateinstitutions for mental diseases or tuberculosis;
(5) All persons under the age of twenty-one years who would beeligible for aid to families with dependent children except for therequirements of subdivision (2) of subsection 1 of section 208.040, and whoare residing in an intermediate care facility, or receiving activetreatment as inpatients in psychiatric facilities or programs, as definedin 42 U.S.C. 1396d, as amended;
(6) All persons under the age of twenty-one years who would beeligible for aid to families with dependent children benefits except forthe requirement of deprivation of parental support as provided for insubdivision (2) of subsection 1 of section 208.040;
(7) All persons eligible to receive nursing care benefits;
(8) All participants receiving family foster home or nonprofitprivate child-care institution care, subsidized adoption benefits andparental school care wherein state funds are used as partial or fullpayment for such care;
(9) All persons who were participants receiving old age assistancebenefits, aid to the permanently and totally disabled, or aid to the blindbenefits on December 31, 1973, and who continue to meet the eligibilityrequirements, except income, for these assistance categories, but who areno longer receiving such benefits because of the implementation of TitleXVI of the federal Social Security Act, as amended;
(10) Pregnant women who meet the requirements for aid to familieswith dependent children, except for the existence of a dependent child inthe home;
(11) Pregnant women who meet the requirements for aid to familieswith dependent children, except for the existence of a dependent child whois deprived of parental support as provided for in subdivision (2) ofsubsection 1 of section 208.040;
(12) Pregnant women or infants under one year of age, or both, whosefamily income does not exceed an income eligibility standard equal to onehundred eighty-five percent of the federal poverty level as established andamended by the federal Department of Health and Human Services, or itssuccessor agency;
(13) Children who have attained one year of age but have not attainedsix years of age who are eligible for medical assistance under 6401 of P.L.101-239 (Omnibus Budget Reconciliation Act of 1989). The family supportdivision shall use an income eligibility standard equal to one hundredthirty-three percent of the federal poverty level established by theDepartment of Health and Human Services, or its successor agency;
(14) Children who have attained six years of age but have notattained nineteen years of age. For children who have attained six yearsof age but have not attained nineteen years of age, the family supportdivision shall use an income assessment methodology which provides foreligibility when family income is equal to or less than equal to onehundred percent of the federal poverty level established by the Departmentof Health and Human Services, or its successor agency. As necessary toprovide MO HealthNet coverage under this subdivision, the department ofsocial services may revise the state MO HealthNet plan to extend coverageunder 42 U.S.C. 1396a (a)(10)(A)(i)(III) to children who have attained sixyears of age but have not attained nineteen years of age as permitted byparagraph (2) of subsection (n) of 42 U.S.C. 1396d using a more liberalincome assessment methodology as authorized by paragraph (2) of subsection(r) of 42 U.S.C. 1396a;
(15) The family support division shall not establish a resourceeligibility standard in assessing eligibility for persons under subdivision(12), (13) or (14) of this subsection. The MO HealthNet division shalldefine the amount and scope of benefits which are available to individualseligible under each of the subdivisions (12), (13), and (14) of thissubsection, in accordance with the requirements of federal law andregulations promulgated thereunder;
(16) Notwithstanding any other provisions of law to the contrary,ambulatory prenatal care shall be made available to pregnant women during aperiod of presumptive eligibility pursuant to 42 U.S.C. Section 1396r-1, asamended;
(17) A child born to a woman eligible for and receiving MO HealthNetbenefits under this section on the date of the child's birth shall bedeemed to have applied for MO HealthNet benefits and to have been foundeligible for such assistance under such plan on the date of such birth andto remain eligible for such assistance for a period of time determined inaccordance with applicable federal and state law and regulations so long asthe child is a member of the woman's household and either the woman remainseligible for such assistance or for children born on or after January 1,1991, the woman would remain eligible for such assistance if she were stillpregnant. Upon notification of such child's birth, the family supportdivision shall assign a MO HealthNet eligibility identification number tothe child so that claims may be submitted and paid under such child'sidentification number;
(18) Pregnant women and children eligible for MO HealthNet benefitspursuant to subdivision (12), (13) or (14) of this subsection shall not asa condition of eligibility for MO HealthNet benefits be required to applyfor aid to families with dependent children. The family support divisionshall utilize an application for eligibility for such persons whicheliminates information requirements other than those necessary to apply forMO HealthNet benefits. The division shall provide such application formsto applicants whose preliminary income information indicates that they areineligible for aid to families with dependent children. Applicants for MOHealthNet benefits under subdivision (12), (13) or (14) shall be informedof the aid to families with dependent children program and that they areentitled to apply for such benefits. Any forms utilized by the familysupport division for assessing eligibility under this chapter shall be assimple as practicable;
(19) Subject to appropriations necessary to recruit and train suchstaff, the family support division shall provide one or more full-time,permanent eligibility specialists to process applications for MO HealthNetbenefits at the site of a health care provider, if the health care providerrequests the placement of such eligibility specialists and reimburses thedivision for the expenses including but not limited to salaries, benefits,travel, training, telephone, supplies, and equipment, of such eligibilityspecialists. The division may provide a health care provider with apart-time or temporary eligibility specialist at the site of a health careprovider if the health care provider requests the placement of such an*eligibility specialist and reimburses the division for the expenses,including but not limited to the salary, benefits, travel, training,telephone, supplies, and equipment, of such an* eligibility specialist.The division may seek to employ such eligibility specialists who areotherwise qualified for such positions and who are current or formerwelfare participants. The division may consider training such current orformer welfare participants as eligibility specialists for this program;
(20) Pregnant women who are eligible for, have applied for and havereceived MO HealthNet benefits under subdivision (2), (10), (11) or (12) ofthis subsection shall continue to be considered eligible for allpregnancy-related and postpartum MO HealthNet benefits provided undersection 208.152 until the end of the sixty-day period beginning on the lastday of their pregnancy;
(21) Case management services for pregnant women and young childrenat risk shall be a covered service. To the greatest extent possible, andin compliance with federal law and regulations, the department of healthand senior services shall provide case management services to pregnantwomen by contract or agreement with the department of social servicesthrough local health departments organized under the provisions of chapter192, RSMo, or chapter 205, RSMo, or a city health department operated undera city charter or a combined city-county health department or otherdepartment of health and senior services designees. To the greatest extentpossible the department of social services and the department of health andsenior services shall mutually coordinate all services for pregnant womenand children with the crippled children's program, the prevention of mentalretardation program and the prenatal care program administered by thedepartment of health and senior services. The department of socialservices shall by regulation establish the methodology for reimbursementfor case management services provided by the department of health andsenior services. For purposes of this section, the term "case management"shall mean those activities of local public health personnel to identifyprospective MO HealthNet-eligible high-risk mothers and enroll them in thestate's MO HealthNet program, refer them to local physicians or localhealth departments who provide prenatal care under physician protocol andwho participate in the MO HealthNet program for prenatal care and to ensurethat said high-risk mothers receive support from all private and publicprograms for which they are eligible and shall not include involvement inany MO HealthNet prepaid, case-managed programs;
(22) By January 1, 1988, the department of social services and thedepartment of health and senior services shall study all significantaspects of presumptive eligibility for pregnant women and submit a jointreport on the subject, including projected costs and the time needed forimplementation, to the general assembly. The department of socialservices, at the direction of the general assembly, may implementpresumptive eligibility by regulation promulgated pursuant to chapter 207,RSMo;
(23) All participants who would be eligible for aid to families withdependent children benefits except for the requirements of paragraph (d) ofsubdivision (1) of section 208.150;
(24) (a) All persons who would be determined to be eligible for oldage assistance benefits under the eligibility standards in effect December31, 1973, as authorized by 42 U.S.C. Section 1396a(f), or less restrictivemethodologies as contained in the MO HealthNet state plan as of January 1,2005; except that, on or after July 1, 2005, less restrictive incomemethodologies, as authorized in 42 U.S.C. Section 1396a(r)(2), may be usedto change the income limit if authorized by annual appropriation;
(b) All persons who would be determined to be eligible for aid to theblind benefits under the eligibility standards in effect December 31, 1973,as authorized by 42 U.S.C. Section 1396a(f), or less restrictivemethodologies as contained in the MO HealthNet state plan as of January 1,2005, except that less restrictive income methodologies, as authorized in42 U.S.C. Section 1396a(r)(2), shall be used to raise the income limit toone hundred percent of the federal poverty level;
(c) All persons who would be determined to be eligible for permanentand total disability benefits under the eligibility standards in effectDecember 31, 1973, as authorized by 42 U.S.C. 1396a(f); or less restrictivemethodologies as contained in the MO HealthNet state plan as of January 1,2005; except that, on or after July 1, 2005, less restrictive incomemethodologies, as authorized in 42 U.S.C. Section 1396a(r)(2), may be usedto change the income limit if authorized by annual appropriations.Eligibility standards for permanent and total disability benefits shall notbe limited by age;
(25) Persons who have been diagnosed with breast or cervical cancerand who are eligible for coverage pursuant to 42 U.S.C. 1396a(a)(10)(A)(ii)(XVIII). Such persons shall be eligible during a period ofpresumptive eligibility in accordance with 42 U.S.C. 1396r-1;
(26) Persons who are independent foster care adolescents, as definedin 42 U.S.C. Section 1396d, or who are within reasonable categories of suchadolescents who are under twenty-one years of age as specified by thestate, are eligible for coverage under 42 U.S.C. Section 1396a(a)(10)(A)(ii)(XVII) without regard to income or assets.
2. Rules and regulations to implement this section shall bepromulgated in accordance with section 431.064, RSMo, and chapter 536,RSMo. Any rule or portion of a rule, as that term is defined in section536.010, RSMo, that is created under the authority delegated in thissection shall become effective only if it complies with and is subject toall of the provisions of chapter 536, RSMo, and, if applicable, section536.028, RSMo. This section and chapter 536, RSMo, are nonseverable and ifany of the powers vested with the general assembly pursuant to chapter 536,RSMo, to review, to delay the effective date or to disapprove and annul arule are subsequently held unconstitutional, then the grant of rulemakingauthority and any rule proposed or adopted after August 28, 2002, shall beinvalid and void.
3. After December 31, 1973, and before April 1, 1990, any familyeligible for assistance pursuant to 42 U.S.C. 601, et seq., as amended, inat least three of the last six months immediately preceding the month inwhich such family became ineligible for such assistance because ofincreased income from employment shall, while a member of such family isemployed, remain eligible for MO HealthNet benefits for four calendarmonths following the month in which such family would otherwise bedetermined to be ineligible for such assistance because of income andresource limitation. After April 1, 1990, any family receiving aidpursuant to 42 U.S.C. 601, et seq., as amended, in at least three of thesix months immediately preceding the month in which such family becomesineligible for such aid, because of hours of employment or income fromemployment of the caretaker relative, shall remain eligible for MOHealthNet benefits for six calendar months following the month of suchineligibility as long as such family includes a child as provided in 42U.S.C. 1396r-6. Each family which has received such medical assistanceduring the entire six-month period described in this section and whichmeets reporting requirements and income tests established by the divisionand continues to include a child as provided in 42 U.S.C. 1396r-6 shallreceive MO HealthNet benefits without fee for an additional six months.The MO HealthNet division may provide by rule and as authorized by annualappropriation the scope of MO HealthNet coverage to be granted to suchfamilies.
4. When any individual has been determined to be eligible for MOHealthNet benefits, such medical assistance will be made available to himor her for care and services furnished in or after the third month beforethe month in which he made application for such assistance if suchindividual was, or upon application would have been, eligible for suchassistance at the time such care and services were furnished; provided,further, that such medical expenses remain unpaid.
5. The department of social services may apply to the federalDepartment of Health and Human Services for a MO HealthNet waiver amendmentto the Section 1115 demonstration waiver or for any additional MO HealthNetwaivers necessary not to exceed one million dollars in additional costs tothe state, unless subject to appropriation or directed by statute, but inno event shall such waiver applications or amendments seek to waive theservices of a rural health clinic or a federally qualified health center asdefined in 42 U.S.C. 1396d(l)(1) and (2) or the payment requirements forsuch clinics and centers as provided in 42 U.S.C. 1396a(a)(15) and1396a(bb) unless such waiver application is approved by the oversightcommittee created in section 208.955. A request for such a waiver sosubmitted shall only become effective by executive order not sooner thanninety days after the final adjournment of the session of the generalassembly to which it is submitted, unless it is disapproved within sixtydays of its submission to a regular session by a senate or house resolutionadopted by a majority vote of the respective elected members thereof,unless the request for such a waiver is made subject to appropriation ordirected by statute.
6. Notwithstanding any other provision of law to the contrary, in anygiven fiscal year, any persons made eligible for MO HealthNet benefitsunder subdivisions (1) to (22) of subsection 1 of this section shall onlybe eligible if annual appropriations are made for such eligibility. Thissubsection shall not apply to classes of individuals listed in 42 U.S.C.Section 1396a(a)(10)(A)(i).
(L. 1967 p. 325, A.L. 1973 S.B. 301, H.B. 48, A.L. 1981 H.B. 894, H.B. 901, A.L. 1982 H.B. 1462, A.L. 1987 H.B. 518, A.L. 1988 H.B. 1139, A.L. 1989 1st Ex. Sess. H.B. 2, A.L. 1990 S.B. 765, A.L. 1991 H.B. 447, A.L. 1993 H.B. 564 merged with S.B. 52, A.L. 1995 S.B. 3, A.L. 2001 H.B. 762, A.L. 2001 1st Ex. Sess. H.B. 3 merged with S.B. 4, et al., A.L. 2005 S.B. 539, A.L. 2007 S.B. 577)Effective 7-02-07
*Word "a" appears in original rolls.