MO HealthNet for Show Me Health Babies (SMHB) Basic Eligibility

Note: Eligibility for this program cannot be determined until a MO HealthNet for Pregnant Woman application has been submitted, processed, and denied due to excessive income or citizenship

ELIGIBILITY FACTOR

REQUIREMENT
PARTICIPANT Participant must be an unborn child, verified by self-attestation of the mother
RESIDENCE Must reside in Missouri.
NEED An unborn child, whose mother was denied for MPW for excessive income-201% of FPL(196% of FPL plus 5% disregard) and does not exceed 305% of FPL(300% of FPL plus the 5% disregard)
An unborn child, whose mother was denied on MPW for citizenship whose income is less than 305% of FPL (300% plus the 5% disregard)
UNINSURED The mother of an unborn child must be uninsured. The mother cannot have health insurance or health insurance that covers pregnancy-related services.
EMPLOYER SPONSORED
INSURANCE		 The Pregnant Women cannot have access to affordable employer sponsored health insurance that provides pre-natal /maternity benefits. Can be verified through self-attestation.
PRIVATE INSURANCE If affordable employer sponsored health insurance is not available, evaluate access to affordable private insurance coverage. (Refer to the Affordability Calculator to determine if affordable insurance is available.)
INELIGIBLE FOR ANY
OTHER MO HEALTHNET
PROGRAMS		 An unborn child is ineligible for the Show-Me Healthy Babies Program if his/her mother is eligible for any other MO HealthNet program that provides full benefits and does not require a premium or a spend down in exchange for coverage.
HOUSEHOLD
COMPOSITION		 Household composition is based on Federal tax filing rules.
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
Use the tax filing status of the Mother of the unborn child