Missouri Medicaid Eligibility 2025: Income Limits, Asset Rules & How to Apply

Missouri Medicaid, officially known as MO HealthNet, provides vital healthcare coverage to low-income residents, including children, pregnant women, parents, seniors, and individuals with disabilities. Administered by the Missouri Department of Social Services (DSS), this state and federally funded program offers various pathways to coverage, each with specific eligibility criteria.

This blog post outlines the 2025 income limits, asset rules, application process, and key considerations for MO HealthNet, with a focus on long-term care for seniors (aged 65+), as well as other eligibility groups. Unlike Mississippi Medicaid, Missouri has expanded Medicaid under the Affordable Care Act (ACA), extending coverage to low-income adults aged 19–64.

Missouri Medicaid Programs

MO HealthNet offers tailored programs to meet diverse needs:

• Institutional / Nursing Home Medicaid: An entitlement program covering nursing home care for those requiring a Nursing Facility Level of Care (NFLOC).
• Home and Community Based Services (HCBS) Waivers: Non-entitlement programs with limited slots, providing services like in-home care, adult day care, and assisted living to delay nursing home placement. Programs like the Aged and Disabled Waiver may have waiting lists.
• Regular Medicaid (Aged, Blind, and Disabled, ABD): An entitlement program for low-income elderly, blind, or disabled individuals, with less stringent medical requirements than long-term care programs.
• Medicaid for Children and Pregnant Women: Covers children up to age 19 and pregnant women, including through the Children’s Health Insurance Program (CHIP).
• Medicaid for Parents and Caretaker Relatives: Covers low-income parents or caretakers of dependent children under 18.
• Medicaid Expansion (Adults 19–64): Covers non-disabled adults with incomes up to 138% of the Federal Poverty Level (FPL), implemented after Missouri’s 2021 voter-approved expansion.

Eligibility for Missouri Medicaid

Eligibility varies by program but generally includes:

• Residency: Must be a Missouri resident.
• Citizenship: Must be a U.S. citizen or have qualifying immigration status (e.g., lawful permanent resident, refugee, or asylee).
• Income: Based on Federal Poverty Level (FPL) or Federal Benefit Rate (FBR). Missouri uses Modified Adjusted Gross Income (MAGI) for children, pregnant women, parents, and expansion adults, with a 5% FPL disregard.
• Assets: Limits apply for long-term care and ABD programs.
• Medical/Functional Need: Long-term care programs require a Nursing Facility Level of Care (NFLOC), assessed through limitations in Activities of Daily Living (ADLs) or Instrumental Activities of Daily Living (IADLs).

Categorical Eligibility: Individuals receiving Supplemental Security Income (SSI) are often automatically eligible for Regular Medicaid (ABD), bypassing some income and asset tests.

Income Limits for Missouri Medicaid

Income limits depend on the program and household size. Below are the 2025 income limits for Missouri, expressed as monthly amounts, based on federal guidelines and MO HealthNet policies.

Key Notes on Income Limits

• Seniors/Disabled (Nursing Home/HCBS): Missouri is an income cap state, requiring income under $2,901/month (single) or $5,802/month (couple). Excess income must be placed in a Qualified Income Trust (QIT) to qualify, with most income allocated to care costs except for a $50/month Personal Needs Allowance, Medicare premiums, and a possible Needs Allowance for a non-applicant spouse (up to $3,948/month if housing/utility costs exceed $793.13/month, effective 7/1/25–6/30/26).
• Married, One Spouse Applying: Applicant’s income limit is $2,901/month; non-applicant spouse’s income is not counted. The non-applicant may receive a Monthly Maintenance Needs Allowance (MMNA).
• Children: Income limits vary by age, with infants up to 194% FPL ($2,596/month) and older children up to 150% FPL ($2,009/month). A 5% FPL disregard applies.
• Pregnant Women: Coverage extends 12 months postpartum, up to 194% FPL ($2,596/month for one).
• Parents/Caretakers: Income limit is 133% FPL ($1,800/month for one), more generous than Mississippi’s 22% FPL.
• CHIP: Covers uninsured children up to 209% FPL ($2,791/month for one).
• Expansion Adults: Covers adults aged 19–64 up to 138% FPL ($2,156/month for one), addressing the coverage gap absent in Mississippi.

2025 Federal Poverty Level (FPL) Guidelines

Use the FPL Calculator to estimate your household’s FPL percentage.

Asset Rules for Missouri Medicaid

Asset limits apply primarily to long-term care and ABD programs.

Long-Term Care Medicaid (Nursing Home and HCBS Waivers)

• Single Applicant: $5,000 in countable assets (e.g., bank accounts, stocks, bonds, secondary properties).
• Married, Both Applying: $10,000 total.
• Married, One Applying: $5,000 for the applicant; $157,920 for the non-applicant spouse (Community Spouse Resource Allowance, CSRA).
• Home Equity Limit: $730,000 for the primary residence (if applicant/spouse resides there or intends to return).

Non-Countable Assets

• Primary home (if applicant/spouse resides there or intends to return)
• One vehicle
• Household goods and personal effects
• Burial spaces or irrevocable burial funds (up to $7,000)
• Life insurance with a face value of $1,500 or less
• Medicaid Compliant Annuities

Medicaid’s Look-Back Rule

Missouri enforces a 60-month look-back period for Nursing Home Medicaid and HCBS Waivers, reviewing asset transfers within 5 years of application. Transfers below fair market value (e.g., gifting) may result in a penalty period of ineligibility. No look-back period applies for Regular Medicaid.

Estate Recovery

Missouri’s MO HealthNet Estate Recovery Program seeks reimbursement for long-term care costs after a beneficiary’s death, often targeting the home if not protected. Consult a Certified Medicaid Planner to safeguard assets.

Regular Medicaid (Aged, Blind, and Disabled)

• Asset Limit: $2,000 for an individual; $3,000 for a couple.
• No home equity limit or look-back period.

Medicaid for Children, Pregnant Women, Parents/Caretakers, and Expansion Adults

• No Asset Test: These programs focus solely on income.

Medical/Functional Requirements

For Nursing Home Medicaid and HCBS Waivers, applicants must demonstrate a Nursing Facility Level of Care (NFLOC), assessed through:

• Limitations in Activities of Daily Living (ADLs): Mobility, bathing, dressing, eating, toileting.
• Limitations in Instrumental Activities of Daily Living (IADLs): Cooking, shopping, managing finances.
• Cognitive or Behavioral Issues: E.g., Alzheimer’s or dementia (diagnosis alone does not guarantee eligibility).

Regular Medicaid (ABD) requires proof of disability or blindness per Social Security Administration criteria but does not require NFLOC.

Federal Policy Changes Affecting Medicaid

As of 2025, federal policy changes may impact MO HealthNet:

• Work Requirements (Starting January 2027): May apply to expansion adults and parents/caretakers, but not seniors, disabled individuals, pregnant women, or children. Missouri has previously explored work requirements.
• Reduced Retroactive Coverage (Starting January 2027): Medicaid will cover only 2 months prior to application (down from 90 days), increasing potential medical debt for late applicants.
• More Frequent Eligibility Checks (Starting December 2026): Beneficiaries must renew eligibility every 6 months, requiring regular documentation to avoid coverage gaps.
• New Out-of-Pocket Costs (Starting October 2028): Non-exempt beneficiaries may face up to $35 per visit for specialist services or procedures, but primary care and preventive services remain free.

Options if Over the Income or Asset Limit

If your income or assets exceed limits, consider:

• Qualified Income Trusts (QITs): Redirect excess income for Nursing Home or HCBS Waivers to meet the $2,901/month limit. The trust is irrevocable, and MO HealthNet must be designated as the beneficiary upon the recipient’s death.
• Irrevocable Funeral Trusts (IFTs): Pre-paid funeral and burial expenses (up to $7,000) are exempt from asset limits.
• Spend Down: Convert countable assets into exempt ones (e.g., home repairs, purchasing a vehicle, or paying off debt). Missouri offers a Medically Needy Spend-Down Program for Regular Medicaid (ABD), allowing individuals to deduct medical expenses to meet income limits.
• Certified Medicaid Planners: Professionals can assist with strategies like Medicaid Compliant Annuities or asset restructuring.

How to Apply for Missouri Medicaid

To apply for MO HealthNet:

1. Online: Use the myDSS Portal or the federal Marketplace. Check eligibility with the MO HealthNet Eligibility Calculator.
2. Phone: Call the Family Support Division at 1-855-373-4636.
3. In-Person or Mail: Submit an application to a local Family Support Division office. Download the application from dss.mo.gov.
4. Assistance: Contact MO HealthNet Participant Services at 1-800-392-2161 or a local Area Agency on Aging at 1-800-243-6060 for long-term care support.

Required Documents: Proof of income, assets, residency, citizenship, Social Security number, and medical records (for long-term care or disability programs). An interview may be required.

Processing Time:

• Standard applications: Up to 45 days (90 days for disability-based applications).
• Expedited processing: Available for urgent cases (e.g., pregnant women via presumptive eligibility for outpatient care).

Frequently Asked Questions

How do I apply for Medicaid in Missouri?

Apply online at mydss.mo.gov or healthcare.gov, by phone at 1-855-373-4636, in person at a Family Support Division office, or by mail with an application from dss.mo.gov.

What are the 2025 Medicaid income limits for Missouri?

For seniors/disabled (Nursing Home/HCBS): $2,901/month (single) or $5,802/month (couple). Regular Medicaid (ABD): $967/month (single) or $1,450/month (couple). Children: up to 194% FPL ($2,596/month for infants). Pregnant women: up to 194% FPL ($2,596/month for one). Parents/caretakers: up to 133% FPL ($1,800/month for one). Expansion adults: up to 138% FPL ($2,156/month for one). CHIP: up to 209% FPL ($2,791/month for one).

Are there asset limits for Missouri Medicaid?

Yes, for long-term care: $5,000 (single), $10,000 (couple, both applying), or $157,920 for a non-applicant spouse. For Regular Medicaid (ABD): $2,000 (single), $3,000 (couple). No asset tests for children, pregnant women, parents/caretakers, or expansion adults.

What is the Medicaid look-back period in Missouri?

A 60-month look-back period applies to Nursing Home Medicaid and HCBS Waivers, penalizing asset transfers below fair market value. No look-back for Regular Medicaid.

Can I qualify for Medicaid if my income or assets are too high?

Yes, through Qualified Income Trusts (QITs), Irrevocable Funeral Trusts (IFTs), spending down assets, or the Medically Needy Spend-Down Program. Consult a Certified Medicaid Planner for assistance.

Why does Missouri cover more adults than Mississippi?

Missouri expanded Medicaid under the ACA, covering adults aged 19–64 up to 138% FPL, closing the coverage gap for non-disabled adults without dependent children, unlike Mississippi, which has not expanded Medicaid.

This guide is based on 2025 federal and Missouri Department of Social Services guidelines. Verify details with MO HealthNet for accuracy.