Medicaid agency: MHD
Missouri Medicaid (MO HealthNet) is administered by the MO HealthNet Division of the Department of Social Services. Managed care operates under Section 1915(b) authority rather than a Section 1115 demonstration. It reached every county in 2017 with the addition of a fourth region, and on July 1, 2022 the regional structure itself was retired in favor of a single statewide contract. Four health plans serve the program: Healthy Blue, Home State Health, Show Me Healthy Kids, and UnitedHealthcare, together covering 1,021,946 members in 2024. A substantial fee-for-service population remains outside managed care: aged, blind, and disabled members, dual eligibles, and everyone receiving long-term services and supports are served fee-for-service, and MO HealthNet maintains a full set of fee-for-service provider manuals and fee schedules alongside the managed care program. Two Section 1115 demonstrations operate alongside managed care: one covering substance use disorder and serious mental illness treatment, approved December 6, 2023, and one extending coverage to former foster care youth. The managed care contracts are currently out for rebid, with proposals due September 2, 2026.
MO HealthNet Managed Care covers children, pregnant women, and adults in family-coverage eligibility groups statewide through four health plans, which enrolled 1,021,946 members in 2024: Healthy Blue (357,698), Home State Health (314,987), UnitedHealthcare (302,089), and Show Me Healthy Kids (47,172). Dual eligibles are not enrolled in managed care at all; they remain fee-for-service. Show Me Healthy Kids and Home State Health are both operated by Centene, Healthy Blue by Anthem, and UnitedHealthcare by Optum. The current roster is up for competitive rebid, with proposals due September 2, 2026.
Long-term services and supports are not part of the managed care benefit. Members receiving LTSS, along with aged, blind, and disabled members generally, are served fee-for-service, with home- and community-based services authorized through twelve active Section 1915(c) waivers. Those waivers are administered by two departments outside DSS rather than by the MO HealthNet Division itself. The Department of Health and Senior Services administers the waivers serving older adults and people with physical disabilities, including the Aged and Disabled, Independent Living, Adult Day Care, AIDS, and Structured Family Caregiving waivers. The Department of Mental Health's Division of Developmental Disabilities administers the developmental disability waivers, including the Comprehensive, Community Support, Partnership for Hope, Missouri Children with Developmental Disabilities, Autism, and Complex Adult waivers. A Brain Injury waiver operates alongside them, and a separate Section 1915(b) authority covers intensive therapeutic residential habilitation services.
Not integrated into managed care
Behavioral health is included in the managed care benefit for members enrolled in a health plan rather than carved out to a single statewide vendor. The Department of Mental Health administers Missouri's specialty behavioral health programs, including community psychiatric rehabilitation and substance use treatment, for both the managed care and fee-for-service populations. A Section 1115 demonstration approved December 6, 2023 expands access to a full ASAM continuum of substance use disorder care statewide alongside a full continuum of mental health treatment services.
Carved in
Dental services are delivered through each member's health plan for managed care enrollees and directly by MO HealthNet for fee-for-service members. There is no separate statewide dental administrator.
Pharmacy has been carved out of managed care capitation statewide since October 1, 2009, so MO HealthNet administers a single pharmacy benefit covering both managed care and fee-for-service members. Conduent holds the Clinical Management Services and Pharmacy Claims and Prior Authorization contract, covering claims processing and prior authorization for that combined population, extended through state fiscal year 2029 while the state procures modular replacement systems.
MTM, Inc. is the non-emergency medical transportation broker for the fee-for-service program, serving 244,150 members in 2024, of whom 163,323 were dual eligible. Managed care members receive transportation through their own health plan rather than through the state broker.
Wipro Infocrossing operates Missouri's Medicaid Management Information System and serves as the state's fiscal agent, under a contract extended through state fiscal year 2029. IBM operates the Business Intelligence Solution enterprise data warehouse. MO HealthNet is replacing the legacy MMIS with separately procured modular systems covering pharmacy benefit administration, prior authorization, managed care compliance, and core claims processing.
164 agency updates tracked for Missouri. Available with Pro.
See them with ProMissouri's Department of Social Services will not adopt optional federal "short-term hardship" exemptions from Medicaid work requirements, covering hospitalization, medical travel, disaster areas, and high-unemployment regions, that states may use under the federal law requiring 80-hour monthly work, school, or volunteer activity for expansion adults starting Jan. 1, 2027. The department says it will instead rely on mandatory caregiver and "medically frail" exemptions to limit bureaucratic complexity, and will verify compliance based on just one month within each six-month reporting period. Advocates, including Legal Services of Eastern Missouri and the American Cancer Society Cancer Action Network, warn the mandatory exemptions require more verification and may not cover people with short-term acute conditions like cancer treatment or hospital stays. As of Sept. 25, 344,669 Missourians were enrolled in the adult expansion group subject to the new requirements.
Missouri's latest Pregnancy-Associated Mortality Review found mental health conditions and substance use disorder contributed to nearly a quarter of pregnancy-related deaths from 2019 to 2023, with 24 of 108 reviewed deaths attributed to these causes. Providers failed to complete mental health or other key screenings in 38 of the deaths reviewed, and nearly 80% of pregnancy-related deaths were deemed preventable, including all mental health and substance use deaths. Screenings for perinatal mental health conditions remain voluntary in Missouri rather than mandatory, and the state received a "C" grade in 2026 from the Policy Center for Maternal Mental Health, up from a D-minus in 2023. The mortality rate was 2.9 times higher for women on Medicaid than those with private insurance, and rural areas, especially northeast Missouri, saw the highest death rates and face acute shortages of mental health providers.
A Missouri Medicaid enrollee has filed a lawsuit challenging a Trump administration rule governing work requirement exemptions, alleging procedural failures resulted in coverage loss. The enrollee, Emily Byrd of Kansas City, lost Medicaid coverage twice due to what the complaint describes as duplicate letters, late notices, and inconsistent information from the Missouri Department of Social Services despite submitting requested documentation. The lawsuit targets federal rules on exemption processes tied to Medicaid work requirements. The case adds to ongoing litigation over state work requirement programs and their administrative burden on beneficiaries.
Missouri published its "Aging with Dignity" Master Plan on Aging in February 2026, the result of a nearly three-year planning effort that gathered input from more than 10,000 residents. The plan is intended to coordinate policies and services for older adults across state agencies and community partners as Missouri's aging population grows. A Center for Health Care Strategies piece describes the plan's development and goals as a model of multisector coordination for aging services. The write-up does not specify an implementation timeline or funding mechanism.
A new March of Dimes report finds that more than 50% of Missouri counties are maternity care deserts with no labor and delivery units or obstetric physicians, affecting nearly 140,000 women of childbearing age. Between 2010 and 2024, nine Missouri counties lost hospital-based obstetric services, driven by high fixed costs, low birth volumes, and higher Medicaid patient shares at rural hospitals. Research shows that after rural counties lose obstetric services, risks of preterm birth, out-of-hospital birth, and delivery at facilities without dedicated obstetric units increase. The closures add an average of 25 minutes to travel times for families near affected facilities.
23 active waivers tracked for Missouri. Available with Pro.
See them with ProNo active solicitations currently tracked for Missouri.
28 managed care contracts tracked for Missouri. Available with Pro.
See them with Pro2 bills tracked for Missouri. Available with Pro.
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