How Health Benefits Work

Disability-Based MO HealthNet

Look at disability-based MO HealthNet if you get SSI or if:

  • You are a U.S. citizen or eligible immigrant
  • You have a disability or are a senior
  • You have low resources, and
  • You have low income.

Is It Right for You?

MO HealthNet is government-funded health coverage for people in certain situations. You may qualify if you:

Note: Children under the age of 19, their parents or caretaker relatives, and pregnant women may also qualify for MO HealthNet. Learn more in DB101's article on MO HealthNet Eligibility for Young People.

Answer the questions on this page to see if you might qualify for MO HealthNet for people with disabilities, the blind or visually impaired, or seniors age 65 and older. If so, it’s probably your best health coverage option because it doesn’t usually have a premium, the copayments for services are generally lower than copayments required by private plans, and MO HealthNet covers more services than most private plans. Also, if you qualify for MO HealthNet, you cannot get government help paying for an individual plan on

Note: DB101 keeps track of changes to health coverage and related laws. DB101 articles and tools have recently been updated to include MO HealthNet's expansion of coverage for adults 18-64 years old (Medicaid Expansion). Get more information about applying for this coverage.

MO HealthNet’s rules for immigrants:

Do You Have a Disability That Meets Social Security’s Standards?

To qualify for disability-based MO HealthNet, you must have a disability that meets Social Security’s definition of disability. For adults, Social Security says you have a disability if:

  • You have a physical or mental impairment or combination of impairments
  • Your impairments limit your ability to work, preventing you from earning Substantial Gainful Activity ($1,550 per month or $2,590 per month if you’re blind), and
  • Your condition has lasted or is expected to last for at least 12 months.

If you currently get Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI), you already meet Social Security’s disability standards. If not, a Medical Review Team looks at your medical records and other documents to see if your disaiblity qualifies for MO HealthNet.

Note: You can also qualify for MO HealthNet if you are 65 years old or older.The other eligibility rules described for disability-based MO HealthNet apply.

Note: Learn about Social Security’s definition of disability for children under 18 in DB101’s Benefits for Young People article.

If you already have a disability determination from Social Security or think that your disability meets Social Security’s standards, or if you are 65 or older, disability-based MO HealthNet might cover you.

Do You Have Very Low Resources?

Resources are money and property you own. For disability-based MO HealthNet, you and your spouse (or your parents if you are under 18) must have very low resources:

  • If you are single, the most you can have is $5,726 in available resources.
  • For couples, the limit is $11,452.

Some resources don’t count towards disability-based MO HealthNet’s resource limit, like the home you live in, one car, and any money you have in an ABLE account.

If your resources are below the limit, disability-based MO HealthNet might cover you.

Do You Have Very Low Income?

To get disability-based MO HealthNet, your countable income has to be low:

  • If you have a disability or are a senior, it must be 85% of the Federal Poverty Guidelines (FPG) or less ($1,067 per month you are single, $1,448 or less for couples).
  • If you are blind, it must be 100% of FPG or less ($1,255 per month if you're single, $1,704 for couples).

Not all of your income is counted. The way your income is counted for disability-based MO HealthNet is very similar to SSI’s countable income calculation:

This means that if you have a disability determination, you might be able to get a job and make $2,000 per month or more without losing your disability-based MO HealthNet, because more than half of your earned income wouldn’t be counted.

If you live alone, try this tool to see if your countable income is below disability-based MO HealthNet’s income limit.

Your Countable Income:

If you live with a spouse, some of their income may be counted and your combined countable income will be compared to the limit for a couple.

If your income is low enough and you meet all other requirements, you should sign up for MO HealthNet.

If your income is too high

If your income is over the standard MO HealthNet limits, you may have two options:

  • MO HealthNet Spend Down: A spend down is like a monthly deductible: you pay the first part of your monthly medical costs and MO HealthNet only pays for your health care expenses after you've paid the spend down. Your monthly spend-down amount depends on your countable income. If you prefer, you can pay your spend-down amount directly to MO HealthNet each month (like a premium). Learn more about the Spend Down program, including answers to Frequently Asked Questions.
  • MO HealthNet's Ticket to Work Health Assurance program: If you work, you may qualify for MO HealthNet through the Ticket to Work Health Assurance program, which has a higher income limit than disability-based MO HealthNet. You might have to pay a monthly premium, depending on your countable income, but the premium will probably be less than what you would pay under the Spend Down program. Learn more about Ticket to Work Health Assurance.

Note: If you work, the Family Support Division will figure out if you qualify for Ticket to Work Health Assurance and MO HealthNet Spend Down, and let you choose the option that is best for you.

More Ways to Qualify for MO HealthNet if You Have a Disability

There are other ways to qualify for MO HealthNet if you have a disability. You might qualify for income-based MO HealthNet if:

  • Your disability does not meet Social Security’s definition of disability. Disability-based MO HealthNet is only for people who have disabilities meeting this standard.
  • You have more resources than are allowed by disability-based MO HealthNet.
  • You make enough money that you would have to pay a monthly premium for Ticket to Work Health Assurance.

You might qualify for disability-based MO HealthNet instead of income-based MO HealthNet if:

  • You make more money at work than income-based MO HealthNet allows. In that case, you could apply for MO HealthNet's Ticket to Work Health Assurance program.
  • You also get Medicare. Income-based MO HealthNet doesn’t cover people getting Medicare, but disability-based MO HealthNet does. It may even help pay your monthly Medicare premiums.
  • You are 65 years old or older.

Learn more about income-based MO HealthNet and Ticket to Work Health Assurance.

How to Sign Up

To apply for MO HealthNet, you can:

If you need help filling out an application, talk to a benefits specialist.

Staying on MO HealthNet

Usually, once approved for MO HealthNet, you continue to qualify as long as your situation doesn’t change. If your income, immigration status, residency, or household size changes, let the Family Support Division (FSD) office know within 10 days of the change. You can do this in person, by phone, or online. When you report your changes, the FSD tells you if you can no longer get MO HealthNet or if you have new health coverage options, like MO HealthNet Spend Down or Ticket to Work Health Assurance.

Learn more