Medicaid Do’s and Don'ts
Medicaid & Medicaid Waivers
Understanding Medicaid
Medicaid (called MO HealthNet in Missouri) is a state and federally funded health insurance program that helps eligible individuals receive medical care. Depending on your eligibility, Medicaid may cover doctor visits, hospital care, prescriptions, therapies, behavioral health services, medical equipment, transportation to medical appointments, and much more.
For many individuals with disabilities, Medicaid is also the gateway to receiving long-term community supports through Medicaid Waiver programs.
Where Do I Apply?
If you believe you or your loved one may qualify for Medicaid, you can apply through the Missouri Family Support Division (FSD).
Apply Online
You may also:
Apply by phone through the Family Support Division.
Visit your local Family Support Division office.
Mail or submit a paper application.
If you are applying because of a disability, blindness, or because you need developmental disability waiver services, additional medical documentation may be required.
What Are Medicaid Waivers?
Medicaid Waivers (also called Home and Community-Based Services (HCBS) Waivers) allow individuals with disabilities to receive services in their homes and communities instead of living in an institution or nursing facility.
Rather than paying only for medical care, waiver programs can pay for supports that help individuals live more independently.
Waivers are designed to promote:
Independence
Community inclusion
Family support
Employment opportunities
Personal choice
Improved quality of life
Missouri currently offers several Developmental Disabilities Medicaid Waivers administered through the Missouri Department of Mental Health.
What Services Can Medicaid Waivers Help Cover?
Depending on the individual's needs and the waiver they receive, services may include:
Personal care assistance
Community support staff
Respite care
Supported employment
Day habilitation programs
Behavioral support services
Nursing services
Assistive technology
Home and vehicle modifications
Specialized medical equipment
Crisis intervention
Family training
Transportation related to waiver services
Each waiver offers different services based on eligibility and assessed need.
What Medicaid Covers (Without a Waiver)
Traditional Medicaid generally covers:
Primary care appointments
Specialist visits
Hospital services
Emergency care
Mental health services
Prescription medications
Physical therapy
Occupational therapy
Speech therapy (when covered)
Laboratory services
X-rays
Preventive care
Some dental and vision services
Durable medical equipment
Coverage varies depending on the Medicaid program you qualify for.
What Medicaid Does NOT Usually Cover Without a Waiver
Without a Home and Community-Based Services Waiver, Medicaid generally does not pay for many long-term support services, such as:
Ongoing in-home caregivers
Personal attendants for daily living
Community habilitation
Long-term respite care
Employment coaching
Home modifications
Vehicle modifications
Independent living supports
Certain assistive technologies outside standard medical coverage
These supports are often available only through waiver programs if the individual meets eligibility requirements.
Missouri Developmental Disability Waivers
Missouri currently offers four primary Developmental Disability waivers:
Comprehensive Waiver
Community Support Waiver
Missouri Children with Developmental Disabilities (MOCDD/Sarah Jian Lopez) Waiver
Partnership for Hope Waiver
Each waiver has different eligibility criteria, funding levels, and available services.
Learn more:
Medicaid Do's
✔ Keep copies of all paperwork.
✔ Report changes in income, address, household size, or insurance promptly.
✔ Renew your Medicaid coverage when requested.
✔ Keep medical appointments.
✔ Maintain communication with your Service Coordinator or Case Manager if you receive waiver services.
✔ Save receipts or documentation when requested.
✔ Ask questions if you don't understand a notice or eligibility decision.
Medicaid Don'ts
✘ Don't ignore renewal notices.
✘ Don't fail to report changes in income or household information.
✘ Don't provide false information on an application.
✘ Don't assume all services are automatically covered.
✘ Don't wait until services are urgently needed before exploring waiver eligibility.
✘ Don't throw away letters from Medicaid or your waiver provider.
How Do I Receive Waiver Services?
Generally, the process includes:
Apply for Medicaid (MO HealthNet).
Apply for eligibility through the Missouri Department of Mental Health Division of Developmental Disabilities if appropriate.
Complete required assessments.
Be assigned a Support Coordinator if eligible.
Develop a Person-Centered Support Plan.
Enroll in an appropriate waiver program if eligible and funding is available.
Helpful Resources
Remember
Medicaid and Medicaid Waivers are different programs that work together. Medicaid provides healthcare coverage, while waiver programs provide long-term supports that help individuals with disabilities live, work, and participate in their communities. Understanding both can help you access the services and supports that best meet your needs.
