State-Funded Missouri Woman’s Health Services Program

PURPOSE: This rule establishes the State-Funded Missouri Woman’s Health Services Program. This program will provide payment for women’s health services for uninsured women who do not qualify for other medical assistance benefits, and would lose their MO HealthNet eligibility sixty (60) days after the birth of their child or sixty (60) days after a miscarriage, and for women ages eighteen (18) to fifty-five (55) who have a net family income of at or below one hundred eighty-five percent (185%) (which is the same as a modified adjusted gross family income of at or below two hundred one percent (201%)) of the Federal Poverty Level (FPL) and have assets totaling no more than two hundred fifty thousand dollars ($250,000), in order to reduce the possibility of a family’s future dependence on welfare as authorized pursuant to section 208.040, RSMo. (1) Uninsured women who do not qualify for other medical assistance benefits, and would lose their MO HealthNet eligibility sixty (60) days after the birth of their child or sixty (60) days after a miscarriage, and women ages eighteen (18) to fifty-five (55) who have a net family income of at or below one hundred eighty-five percent (185%) (which is equivalent to a modified adjusted gross family income of at or below two hundred one percent (201%)) of the Federal Poverty Level (FPL) and have assets totaling no more than two hundred fifty thousand dollars ($250,000), shall be eligible to receive medical services to the extent and in the manner provided in this regulation. Uninsured women who do not qualify for other medical assistance benefits, and would lose their MO HealthNet eligibility sixty (60) days after the birth of their child or sixty (60) days after a miscarriage regardless of income, and women ages eighteen (18) to fifty-five (55) who have a net family income of at or below one hundred eighty-five percent (185%) (which is equivalent to a modified adjusted gross family income of at or below two hundred one percent (201%)) of the Federal Poverty Level (FPL) and have assets totaling no more than two hundred fifty thousand dollars ($250,000), will continue to be eligible for women’s health services only. Women’s health services are defined as: pelvic exams and pap tests, sexually transmitted disease testing and treatment (the treatments of medical complications occurring from the sexually transmitted disease are not covered for this program), family planning counseling/education on various methods of birth control, United States Department of Health and Human Services approved methods of contraception including sterilization and x-ray services related to the sterilization, and drugs (excluding antiretrovirals), supplies, or devices related to the women’s health services described in this rule when they are prescribed by a physician or advanced practice nurse, subject to the National Drug Rebate Program requirements. (2) Uninsured women who do not qualify for other benefits, and would lose their MO HealthNet eligibility sixty (60) days after the birth of their child or sixty (60) days after a miscarriage, and women ages eighteen (18) to fifty-five (55) who have a net family income of at or below one hundred eighty-five percent (185%) (which is equivalent to a modified adjusted gross family income of at or below two hundred one percent (201%)) of the Federal Poverty Level (FPL) and have assets totaling no more than two hundred fifty thousand dollars ($250,000), are not required to pay a co-payment for women’s health services. (3) The Department of Social Services, MO HealthNet Division shall provide for granting an opportunity for a fair hearing to any applicant or participant whose claim for benefits under the State-Funded Missouri Woman’s Health Services Program is denied by the MO HealthNet Division. The state hearing officers shall have authority to conduct state level hearings of an appeal nature and shall serve as direct representative of the director of the MO HealthNet Division. (4) Reimbursement. Funding of the family planning and family planning-related services, pregnancy testing, sexually transmitted disease testing and treatment, including pap tests and pelvic exams, and follow-up services of the Missouri Woman’s Health Services Program shall be from general revenue only and none of the funds appropriated may be expended to directly or indirectly subsidize abortion services or procedures or administrative functions, and none of the funds appropriated herein may be paid or granted to an organization that provides abortion services. An otherwise qualified organization shall not be disqualified from receipt of these funds because of its affiliation with an organization that provides abortion services provided that the affiliated organization that provides abortion services is independent of the qualified organization. An independent affiliate that provides abortion services must be separately incorporated from any organization that receives these funds. Such services shall be available to uninsured women who are at least eighteen (18) to fifty-five (55) years of age who have a net family income of at or below one hundred eighty-five percent (185%) (which is equivalent to a modified adjusted gross family income for the household size of at or below two hundred one percent (201%)) of the Federal Poverty Level (FPL) and who is a legal resident of the state. AUTHORITY: sections 208.040, 208.201, and 660.017, RSMo 2016.* Emergency rule filed Sept. 13, 1999, effective Sept. 23, 1999, terminated Oct. 15, 1999. Original rule filed Aug. 16, 1999, effective March 30, 2000. Amended: Filed March 29, 2001, effective Oct. 30, 2001. Emergency amendment filed June 7, 2002, effective July 1, 2002, expired Dec. 27, 2002. Amended: Filed June 11, 2002, effective Nov. 30, 2002. Emergency amendment filed June 7, 2005, effective July 1, 2005, expired Dec. 27, 2005. Amended: Filed June 15, 2005, effective Dec. 30, 2005. Amended: Filed May 14, 2009, effective Nov. 30, 2009. Amended: Filed Sept. 15, 2016, effective April 30, 2017. *Original authority: 208.040, RSMo 1939, amended 1941, 1949, 1951, 1953, 1955, 1957, 1973, 1977, 1982, 1983, 1984, 1987, 1994, 1999, 2001, 2009, 2015; 208.201, RSMo 1987, amended 2007; and 660.017, RSMo 1993, amended 1995.