Medicaid
Medicaid Compliance & Expansion Resources for Missouri Hospitals
Medicaid is a vital program that provides essential health coverage to millions of Missourians, including low-income individuals, children, pregnant women, seniors and people with disabilities. Hospitals are critical to ensuring Medicaid beneficiaries receive high-quality care while maintaining compliance with state and federal regulations.
MHA provides guidance and resources to help hospital administrators and operational teams navigate these often complex Medicaid requirements while remaining compliant and optimizing reimbursement processes.
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Looking for more tools and insights on Medicaid compliance and reimbursement? MHA provides resources to help hospitals navigate Medicaid policies, optimize financial performance and enhance patient care.
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Missouri Medicaid Expansion
In August 2020, Missouri voters approved Medicaid expansion, broadening coverage and increasing access to care and reducing uncompensated hospital costs. Hospitals can leverage expansion-related resources to:
- Educate eligible patients about expanded coverage options and enrollment
- Streamline financial assistance programs to help patients navigate Medicaid eligibility
- Track utilization trends to assess the impact of expansion on hospital operations
By ensuring compliance and efficiency, hospitals can improve Medicaid patient care, reduce administrative burdens and strengthen financial sustainability.
Medicaid Status Updates for 2024
Missouri hospitals must stay informed about recent Medicaid changes to ensure compliance, accurate reimbursements and efficient patient care. The following updates highlight key policy adjustments affecting eligibility, funding and application processes:
- Expanded Coverage Eligibility – Medicaid expansion now covers adults under age 65 with household incomes up to 138% of the federal poverty level (e.g., $20,782 for individuals and $35,631 for a household of three).
- Federal Funding Support – The federal government funds 90% of expansion costs with an additional 5% matching rate for the non-expanded Medicaid population.
- Medicaid Enrollment Changes – Following the end of the continuous coverage rule, enrollment dropped from 334,000 in April 2024 to under 300,000 by June 2024.
- Application Processing Delays – Increased applications in July 2024 caused processing delays, prompting a statewide effort to reduce wait times for approvals.
- Updated Verification Processes – As of June 3, 2024, hospitals must verify birth records using the Department of Health Birth Name Inquiry and confirm citizenship and identity through the Systematic Alien Verification for Entitlements system.
More Resources on Medicaid Expansion
Toolkits & Messaging Medicaid Enrollment
Medicaid Disproportionate Share Hospital Payments
Staff Contact: Kim Duggan
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573-893-3700 | ext. 1345
The Medicaid Disproportionate Share Hospital program provides additional funding to hospitals that serve a large number of low-income and uninsured patients. These payments help offset uncompensated care costs and ensure continued access to health care for vulnerable populations.
To remain compliant and maximize DSH funding, hospitals should:
- Understand eligibility criteria – Hospitals must meet specific thresholds for Medicaid and uninsured patient volume.
- Maintain accurate reporting – Proper documentation of uncompensated care costs is essential for receiving payments.
- Stay updated on federal and state funding changes – DSH payments are subject to policy updates and funding adjustments at both levels.
By ensuring compliance and efficiency, hospitals can improve Medicaid patient care, reduce administrative burdens and strengthen financial sustainability. Consult the following resources for more detailed information on how DSH will affect your institution.
Utilizing Federal Reimbursement Allowance
Staff Contact: Kim Duggan
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573-893-3700 | ext. 1345
The Federal Reimbursement Allowance program is a crucial funding mechanism that supports Missouri hospitals by leveraging federal matching dollars to enhance Medicaid funding. Established in 1991 as a voluntary initiative, FRA became a provider tax program in 1992, helping the state secure additional federal funding.
Hospitals contribute to the FRA program, and these funds are used by Missouri’s Medicaid program, MO HealthNet, to generate federal matching dollars. This model helps reduce the burden on state general revenue and ensures continued investment in Medicaid services.
Key aspects of the FRA program include:
- Maximizing federal Medicaid funding – FRA allows Missouri to draw down additional federal dollars for Medicaid services
- Supporting hospital financial stability – FRA contributions help offset the cost of Medicaid patient care and uncompensated services
- Reducing reliance on state general revenue – By leveraging federal funding, Missouri can allocate general revenue to other state priorities
Understanding and complying with FRA regulations is essential for hospitals to sustain Medicaid funding and continue providing health care services to Missouri’s most vulnerable populations. To better understand how these programs continue to develop over time, see how laws have evolved since the FRA’s creation in 1991.
MO HealthNet Managed Care
Staff Contact: Nate Percy
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573-893-3700 | ext. 1338
Missouri’s MO HealthNet Managed Care Program provides Medicaid benefits through managed care organizations, which oversee patient care coordination and provider reimbursements. Hospitals working with MO HealthNet Managed Care should:
- Understand contract terms with MCOs to ensure proper reimbursement and compliance
- Optimize care coordination efforts to improve patient outcomes and reduce unnecessary hospitalizations
- Stay informed on policy updates affecting managed care operations
For more details, visit the Missouri Department of Social Services’ Managed Care Program.