What does MO HealthNet cover in Missouri?

Yes, MO HealthNet (Missouri Medicaid) covers dental services, but the level of coverage depends heavily on your age and eligibility category.

Coverage Details by Group

• Children, Pregnant Women, the Blind, and Nursing Facility Residents: Receive comprehensive dental services, which include routine exams, cleanings, X-rays, fillings, and some orthodontic care (if specific medical criteria are met).
• General Adults: Adult dental benefits include routine dental exams, cleanings, X-rays, and care related to trauma of the mouth, jaw, or teeth. However, major and expensive restorative services—such as crowns, root canals, and dentures—are not covered by standard MO HealthNet.

You can check specific provider options or details through the Missouri Department of Social Services or search for participating local providers via the MO HealthNet FFS Provider Search.

For an individual, the income limit for MO HealthNet expansion adult Medicaid in Missouri is $21,226 per year (about $1,835 a month), and for a family of four, it is $43,890 per year (about $3,795 a month).

Income Limits by Household Size (Expansion Adults)

For adults ages 19 to 64 qualifying under Missouri's expansion guidelines (133% of the federal poverty level plus the standard 5% disregard), annual limits include:

• 1 person: $21,226
• 2 people: $28,781
• 3 people: $36,335
• 4 people: $43,890

You can check your specific status or submit an application through the Missouri Department of Social Services.

Limits for Other Groups

Income thresholds vary depending on your specific category:

• Pregnant women and infants under age 1: Higher limits up to 196% of the federal poverty level ($31,282 for a single-person household equivalent).
• Aged, blind, or disabled (ABD): Lower categorical income limits apply, though Missouri operates as a "medically needy" spend-down state if your income exceeds the non-spenddown limit (such as $1,131 per month for a single individual).

In Missouri, the amount of money you can make and still qualify for Medicaid (called MO HealthNet) depends heavily on your household size and which eligibility group you fall into.

The primary monthly and annual gross income limits are outlined below:

1. Low-Income Adults (Ages 19–64)

Thanks to Missouri's Medicaid expansion, adults in this age bracket can qualify based on income alone. The income threshold is 138% of the Federal Poverty Level (FPL).

(Note: There is no asset/resource limit for this specific adult expansion group).

2. Children and Pregnant Individuals

Missouri provides higher income thresholds to protect kids and expecting parents.

• Pregnant Individuals: Up to 201% FPL (about $2,673/month for a single person or $4,576/month for a family of three). Coverage through the CHIP program expands this limit even further up to 305% FPL.
• Children (Ages 1–18): Standard coverage goes up to 155% FPL (about $2,061/month for a household of one). Children in households making up to 305% FPL may still qualify for the Children’s Health Insurance Program (CHIP), though a monthly premium may be required.

3. Seniors (65+) and Individuals with Disabilities

For the Aged, Blind, and Disabled (ABD) program, the income caps are lower, and an asset test applies. However, Missouri uses a more generous asset limit than most states, allowing a single applicant to keep up to $6,220.50 in countable resources ($12,441 for a couple).

• Standard Income Limit: $1,131/month for a single individual and $1,533/month for a married couple.
• The "Spend Down" Rule: If you are a senior or disabled and your income is higher than these limits, you are not automatically disqualified. Missouri allows a "spend-down" program. This works like an insurance premium; if your medical bills or monthly payments offset your excess income down to the baseline limit, your Medicaid coverage will activate for that month.

To get a precise evaluation or file an application, you can visit the official Missouri Department of Social Services Portal.

Medicaid does not check your bank account on a continuous or daily schedule, but rather reviews your finances at specific key milestones.

When Medicaid Checks Your Bank Account

• Initial Application: Your accounts are checked when you first apply to verify that your resources meet the state's financial eligibility rules.
• Annual Renewals: Most beneficiaries must renew their eligibility once a year, prompting a yearly review of updated financial information or asset data.
• Life and Financial Changes: If you report a major change—such as an inheritance, property sale, or increase in income—the agency may re-evaluate your accounts.
• Discrepancies: If automated electronic systems flag an inconsistency, a manual review or request for bank statements can happen at any time.

How the Check Works

• Asset Verification System (AVS): For programs that require an asset test (such as for seniors, individuals with disabilities, or long-term care), states use an electronic Asset Verification System to query financial institutions for account balances. AVS shows balances and active accounts, not full daily transaction histories unless requested.
• The 60-Month Look-Back: For nursing home care or long-term services, Medicaid applies a 5-year (60-month) look-back period to review past asset transfers and large financial gifts.
• MAGI Groups: If you apply under expansion rules (such as adults aged 19–64, parents, or pregnant individuals based on Modified Adjusted Gross Income), states generally do not check bank balances or enforce an asset limit—they only look at income.

For most adults in states that expanded Medicaid, any household income above 138% of the Federal Poverty Level (FPL) is too high for standard adult Medicaid.

In 2026, 138% of the FPL equals about $1,481 per month (or roughly $17,773 per year) for a single individual. For a family of three, it is about $2,530 per month (or roughly $30,302 per year).

General Income Limits

• Expanded States: Adults under 65 usually qualify if income is at or below 138% FPL.
• Non-Expansion States: Limits are often much lower. Adults without children, disabilities, or pregnancy often do not qualify at all if they make over a few hundred dollars a month.
• Children and Pregnant Individuals: Income limits are much higher, often ranging from 200% to over 300% of the FPL, depending on the state.
• Long-Term Care / Seniors (65+): Gross monthly limits for nursing homes or home care are typically capped around $2,982 per month for an individual in many states, though excess income can sometimes be placed into a special trust.

What If Your Income Is Too High?

• Marketplace Insurance: If you make too much for Medicaid, you may qualify for tax credits to buy a plan on HealthCare.gov.
• Spend-Down Programs: Some states let you subtract high medical bills from your income to reach the eligibility limit.