Benefits for Young People

MO HealthNet Eligibility for Young People who Work

A lot of people are afraid that if they get a job, they’ll lose their MO HealthNet benefits, but often that’s not true. If you have a disability, you can usually keep your health coverage benefits, which are so important to your health and well-being, even after you get a job. In addition, your job may supply you with private health benefits that can also help you get the health care you need.

Here we’ll talk about different ways you can keep getting MO HealthNet after you get a job. Elsewhere in this article, we’ll talk about getting private health coverage.

If you have a disability, there are three main ways you can continue to get MO HealthNet even if you make more money at work than MO HealthNet’s income limit seems to allow:

  1. You can get MO HealthNet with a spend down
  2. You can get MO HealthNet through the Supplemental Security Income (SSI) 1619(b) rule
  3. You can get MO HealthNet through a program called the Ticket to Work Health Assurance (TWHA) program

To qualify through these you must:

  • Have or apply for a Social Security number
  • Live in Missouri and intend to remain in the state
  • Be a U.S. citizen or an eligible noncitizen
  • You must have low resources:
    • Less than $5,909.25 ($11,818.45 for couples) to qualify for the spend down or TWHA
    • Less than $2,000 for MO HealthNet based on the 1619(b) rule ($3,000 for couples)

Note: You can open an ABLE account where over time you can save up any amount of resources and not have them counted by MO HealthNet. Learn more about ABLE accounts.

However, the amount of money you can make and whether you have to pay a monthly premium or spend money of your own for care depends on your income. Here we’ll explain the differences between these three rules.

How to apply for MO HealthNet when you work

The MO HealthNet website has instructions on how to apply for health coverage online, by phone, or by mail. You don’t have to tell FSD that you want to apply for the spend down or for the Ticket to Work Health Assurance program. They’ll look at your application and figure out which is the best MO HealthNet program for you.

If you were getting SSI benefits and now qualify for MO HealthNet through 1619(b) status, you need to report this to your FSD office (how to report this is explained later in this article).

If you need help completing your application, talk to a Benefits Specialist.

MO HealthNet with a Spend Down Eligibility

If you make more than MO HealthNet’s income limit for people with disabilities, you may qualify for MO HealthNet with a spend down. A spend down is like an insurance deductible or an insurance premium. With a spend down, you are responsible for part of your medical expenses each month before MO HealthNet coverage will start.

Every month when you meet the spend down, you will get MO HealthNet coverage. When you don’t meet the spend down, you won’t get MO HealthNet coverage. If you do not have health care expenses every month, you may choose to pay the spend down some months and not pay it in other months.

There are three ways you can meet your spend down:

  1. You may send a payment to MO HealthNet. You will have coverage for the whole month that you pay for.
  2. You may have your payment taken directly out of your bank account on the 10th of each month by the MO HealthNet Division. To have your payment automatically taken out of your bank account, you must complete the Spend Down Automatic Withdrawal Form.
  3. You may use bills for medical services to reach the spend down amount. When the amount of the services you get reaches your spend down amount, you must give the bills to your eligibility specialist at your local Family Support Division (FSD) office. MO HealthNet coverage will start the day you reach your spend down amount. You are responsible for the spend down amount.

Thomas has a $400 monthly spend down. He doesn’t pay it every month, because he doesn’t always need medical treatment. Instead, he submits copies of his bills for the first $400 in medical expenses he has in a month to the Family Support Division (FSD) and then MO HealthNet pays the rest.

In April, he incurs $700 in medical expenses. Thomas submits bills for the first $400 to his FSD eligibility specialist who activates his MO HealthNet coverage. MO HealthNet will pay the remaining $300. In May, Thomas has only $50 in medical bills. Since he doesn’t have enough bills to meet the full $400 spend down amount for May, MO HealthNet will not pay for any medical expenses in May.

SSI 1619(b) Eligibility

If you’re on Supplemental Security Income (SSI), there is a special rule that allows you to keep your MO HealthNet coverage even when your earned income is too high to get any SSI cash benefits. This rule is called 1619(b). Thanks to 1619(b), you can have up to $44,287 in gross earnings per year without losing your MO HealthNet.

To get MO HealthNet based on 1619(b), FSD has to obtain documentation that you qualify from the Social Security Administration (SSA). SSA does not send this information to the local FSD office; the FSD office will request that you get the documentation from SSA. Once the FSD gets this documentation, FSD will approve you for MO MO HealthNet as long as you continue to qualify for 1619(b).

Learn more about 1619(b) in DB101's SSI article.

If You Qualify for the Ticket to Work Health Assurance (TWHA) Program

If you have a disability and are working, you may be able to continue getting MO HealthNet thanks to a program called Ticket to Work Health Assurance (TWHA) even if you are not eligible for 1619(b). If you were never on SSI benefits, but have a disability that meets Social Security’s definition of disability, you may also be able to get MO HealthNet coverage through TWHA.

With TWHA, you can make as much as $90,840 per year and continue to get MO HealthNet benefits. If you get MO HealthNet through TWHA, you may have to pay a monthly premium to be covered. The premium depends on your income and family situation, up to a maximum of $211.

You can learn more about Ticket to Work Health Assurance in DB101's How Health Benefits Work article.

The bottom line

All three of these ways of qualifying for MO HealthNet – the spend down, 1619(b), and the Ticket to Work Health Assurance (TWHA) program – are great options if you like your current MO HealthNet coverage and start working. You don’t have to be afraid you will lose your health coverage!

For more information about your health coverage options, see DB101's How Health Benefits Work article. You can also try DB101’s School and Work Estimator to get an idea of what type of MO HealthNet you qualify for.

Learn more