MO HealthNet for Pregnant Women Basic Eligibility Requirements

SOCIAL SECURITY NUMBER

Pregnant woman must furnish or apply for one.*

CITIZENSHIP AND IDENTITY

Must be a U.S. citizen or a qualified alien.

RESIDENCE

Must reside in Missouri.

HOUSEHOLD COMPOSITION

Household composition is based on Federal tax filing rules. Include the unborn child(ren) in the household.

Tax filer households: intend to file a federal income tax return for the year coverage is requested. Households consists of the tax filer and individuals to be claimed as dependents:

• Parents / Stepparents

• Children and their siblings including stepchildren

• Children over age 19 (when claimed as dependents)

• Note: some exceptions apply for individuals who expect to be claimed as dependents

• The parents of a person under age 19 must be included in the household composition and the parents’ income is counted even if the child claims he is a non-dependent tax filer. These individuals fall under non-filer rules because they are children who are not claimed as tax dependents

Non-filer households: do not plan to file a federal income tax return nor expect to be claimed as a tax dependent for the year coverage is requested. Households include the family members who live with the individual:

• The individual requesting coverage

• His/her spouse

• His/her Children and stepchildren

• For children, include:

  • parents / stepparents

  • dependent siblings / stepsiblings under age 19

PREGNANCY

Accept the individual’s statement of pregnancy and expected date of delivery unless questionable.

MAGI ELIGIBILITY

Federal income tax rules determine how income is counted. Adjusted gross income cannot exceed MAGI income limits for the household’s size. Household income is first compared to the MO HealthNet for Families (MHF) MAGI income limits for the household size.

If ineligible under MHF income limits, a determination is made based on 141% of the federal poverty level.

If ineligible at 141% FPL, a determination is made based on 196% of the federal poverty level.

If household income exceeds 196% FPL, client is ineligible for MPW.

CONTINUOUS ELIGIBILITY

Pregnant Women who are determined eligible for MPW remain eligible when subsequent changes in income exceed the limits of the program. This “continuous” coverage ends the last day of their 12th month postpartum period.

The prior quarter period is included in determining “continuous eligibility”. If an applicant is eligible for at least one month in the prior quarter, the “continuous” provision applies.