The Henry J. Kaiser Family Foundation  
The Henry J. Kaiser Family Foundation
KFF.org Medicaid/SCHIP HomeMedicaid Benefits: Online DatabaseMedicaid Benefits: Online Database
Search
This tool only
Customize Your Search
Home Benefits by State Benefits by Service About this Data

Show year(s):





Show data by category:
Acute Care Services
Long-Term Care Services


Switch to another state...

Benefits by State: Missouri (October 2008) Notes
 
 
 
Print Print Email Share this
 
 


Acute Care Services

Is the Benefit Covered? Copayment Requirement Prior Approval Requirement Coverage Limitations Reimbursement Methodology Populations Covered


Institutional and Clinic Services
Clinic Services, by an organized facility or clinic not part of a hospital: Freestanding Ambulatory Surgery Center
Yes Coverage limited to specified procedures Fee for service, using an all-inclusive payment per episode of care CN & MN
Clinic Services, by an organized facility or clinic not part of a hospital: Public Health and Mental Health Clinics
Yes $.50/day Fee for service CN & MN
Federally Qualified Health Center Services
Yes $2/day Cost based payment CN & MN
Inpatient Hospital Services, other than in an Institution for Mental Diseases
Yes $10/admission, except emergencies and transfers Admissions for specified surgical procedures LOS limited to 75th percentile of published guidelines for region or days certified by state's Utilization Review authority, special schedule for rehab services Prospective cost based per diem or reasonable charge CN & MN
Outpatient Hospital Services
Yes $3/day Specified services Selected elective surgeries require second opinion Percentage of charge CN & MN
Rehabilitation Services: Mental Health and Substance Abuse
Yes Services limited to the severely mentally ill Fee for service CN & MN
Rural Health Clinic Services
Yes $2/day Prospective cost based rate/visit or certified cost/encounter CN & MN
Practitioner Services
Certified Registered Nurse Anesthetist Services
Yes $.50/day Fee for service CN & MN
Chiropractor Services
No
Dental Services
Yes $.50-$3/ service depending on payment Specified services Exam and cleaning 2/year except adults who are not pregnant, blind or residing in nursing facilities are limited to trauma care related to facial injury or treatment of health-impacting disease or medical condition Fee for service CN & MN
Medical and Remedial Care - Other Practitioners
Medical/Surgical Services of a Dentist
Yes $.50-$3/service depending on payment Fee for service CN & MN
Nurse Midwife Services
Yes $1/day Services limited to women age 15 and older and infants up to 2 months Fee for service CN & MN
Nurse Practitioner Services
Yes $1/day Fee for service CN & MN
Optometrist Services
Yes $.50-$3/service, depending on payment 1 vision exam/year with or without refraction except adults who are not pregnant, blind or residing in nursing facilities are limited to 1 exam/2 years Fee for service CN & MN
Physician Services
Yes $1/day Specified procedures require a second opinion Fee for service CN & MN
Podiatrist Services
Yes $.50-$3/service, depending on payment Specified services are no longer covered for adults who are not pregnant, blind or residing in nursing facilities Fee for service CN & MN
Psychologist Services
Yes $2/day Yes Fee for service CN & MN
Prescription Drugs
Prescription Drugs
Yes $.50-$2/Rx depending on drug cost Lower of AWP-10.43% or WAC+10%, plus $4.09 dispensing fee CN & MN
Physical Therapy and Other Services
Occupational Therapy Services
Yes Adult coverage limited to those who are pregnant, blind or residing in nursing facilities Fee for service CN & MN
Physical Therapy Services
Yes Adult coverage limited to those who are pregnant, blind or residing in nursing facilities Fee for service CN & MN
Services for Speech, Hearing and Language Disorders
Yes Adult coverage limited to those who are pregnant, blind or residing in nursing facilities Fee for service CN & MN
Products and Devices
Dentures
Yes 5% of payment for denture and related services Yes 1 full upper and/or lower denture or 1 partial denture/lifetime, reline after 1 year, adult coverage limited to those who are pregnant, blind or residing in nursing facilities Fee for service CN & MN
Eyeglasses
Yes $.50-$3/item or service, depending on payment 1 pair eyeglasses/2 years, replacement of lenses only if specified diopter criteria met Fee for service CN & MN
Hearing Aids
Yes $.50-$3/service, depending on payment New or replacement hearing aid 1 hearing aid/4 years, adult coverage limited to those who are pregnant, blind or residing in nursing facilities Fee for service CN & MN
Medical Equipment and Supplies
Yes Yes Adult coverage other than for pregnant or blind limited to specified items unless provided through home health plan of care Fee for service CN & MN
Prosthetic and Orthotic Devices
Yes Specified services Adult coverage other than for pregnant or blind does not include orthotics unless provided through home health plan of care Fee for service CN & MN
Transportation Services
Ambulance Services
Yes Fee for service CN & MN
Non-Emergency Medical Transportation Services
Yes $2/day See service-specific FN CN & MN
Other Services
Diagnostic, Screening and Preventive Services
Yes Fee for service CN & MN
Early and Periodic Screening, Diagnosis and Treatment
See service-specific FN.
Extended Services for Pregnant Women
Family Planning Services
See service-specific FN.
Laboratory and X-Ray Services, outside Hospital or Clinic
Yes $1/day Fee for service CN & MN
Targeted Case Management
Yes $1/day Fee for service CN & MN


Long-Term Care Services

Community Based Care
Home and Community Based Services Waiver
Yes Services for the following populations: 2, 4, 5, 7 & 8 - See service-specific FN Dependent upon the services provided CN & MN
Home Health Services, includes nursing services, home health aides, and medical supplies/equipment
Yes 100 nursing and home health aide visits/year, adult coverage for therapies limited to those who are pregnant or blind Fee for service CN & MN
Hospice Care
Yes Two 90-day periods and one 60-day period with additional periods as necessary Prospective rates based on Medicare methodology CN & MN
Personal Care Services
Yes Care must be supervised by RN, alternative to institutional placement Fee for service with payment ceiling at monthly nursing facility cost cap CN & MN
Private Duty Nursing Services
No
Program of All-Inclusive Care for the Elderly
Yes See service-specific FN Capitated payment CN
Institutional Care
Inpatient Hospital, Nursing Facility and Intermediate Care Facility Services In Institutions for Mental Diseases, age 65 and older
Yes 12 therapeutic leave days/6 months Prospective cost based per diem CN & MN
Inpatient Psychiatric Services, under age 21
Yes Prospective cost based per diem, some facilities receive standard rate CN & MN
Intermediate Care Facility Services for the Mentally Retarded
Yes 12 therapeutic leave days/6 months Prospective cost based per diem with limits for private facilities, cost based payment for public facilities CN & MN
Nursing Facility Services, other than in an Institution for Mental Diseases
Yes 12 therapeutic leave days/6 months Prospective per diem based on cost CN & MN
Religious Non-Medical Health Care Institution and Practitioner Services
No


Notes: This State has an approved Section 1115 Waiver from CMS, funded by both Title XIX and Title XXI, under which it initially extended Medicaid eligibility to a number of previously uninsured individuals. Recent cost-cutting initiatives have eliminated coverage for all expansion populations except children under age 19 living in families with income at or below 300 percent of the federal poverty level (FPL). The State’s single benefit family planning program has been included under this waiver, however the information provided in the tables does not reflect policies applicable to single benefit programs. These cost-cutting initiatives have also forced the State to terminate its Medicaid for the Working Disabled program implemented in 2002 through the Ticket to Work and Work Incentives Improvement Act (TWWIIA) and to limit covered services for some Medicaid beneficiaries.  Within federal constraints, any identified copayment requirements are applicable to beneficiaries age 18 and older, except the blind; beneficiaries eligible for both Medicare and Medicaid are exempt from cost sharing if program payment is limited to coinsurance or deductible amounts. The copayment requirement for physician and related services is applicable to and in addition to any amount payable to hospitals or labs for services.
 
 
Copyright 2006 The Henry J. Kaiser Family Foundation Privacy Policy Help Contact