Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 70 - MO HealthNet Division › Chapter 4 - Conditions of Participant Participation, Rights and Responsibilities › Section 13 CSR 70-4.090 - State-Funded Missouri Woman's Health Services Program

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This amendment changes the name of the
				  program that pays for woman's health services for uninsured women, clarifies
				  the income limits for the program, suspends the federal expenditure authority
				  for the program, and restricts payment for woman's health services for
				  uninsured women from being made to any organization that provides abortion
				  services.
PURPOSE: This rule establishes the State-Funded
				  Missouri Woman's Health Services Program. This program will provide payment for
				  women's health services for uninsured women who do not qualify for other
				  medical assistance benefits, and would lose their MO HealthNet eligibility
				  sixty (60) days after the birth of their child or sixty (60) days after a
				  miscarriage, and for women ages eighteen (18) to fifty-five (55) who have a net
				  family income of at or below one hundred eighty-five percent (185%) (which is
				  the same as a modified adjusted gross family income of at or below two hundred
				  one percent (201%)) of the Federal Poverty Level (FPL) and have assets totaling
				  no more than two hundred fifty thousand dollars ($250,000), in order to reduce
				  the possibility of a family's future dependence on welfare as authorized
				  pursuant to section
				  208.040,
				  RSMo.
(1) Uninsured women who
				do not qualify for other medical assistance benefits, and would lose their MO
				HealthNet eligibility sixty (60) days after the birth of their child or sixty
				(60) days after a miscarriage, and women ages eighteen (18) to fifty-five (55)
				who have a net family income of at or below one hundred eighty-five percent
				(185%) (which is equivalent to a modified adjusted gross family income of at or
				below two hundred one percent (201%)) of the Federal Poverty Level (FPL) and
				have assets totaling no more than two hundred fifty thousand dollars
				($250,000), shall be eligible to receive medical services to the extent and in
				the manner provided in this regulation. Uninsured women who do not qualify for
				other medical assistance benefits, and would lose their MO HealthNet
				eligibility sixty (60) days after the birth of their child or sixty (60) days
				after a miscarriage regardless of income, and women ages eighteen (18) to
				fifty-five (55) who have a net family income of at or below one hundred
				eighty-five percent (185%) (which is equivalent to a modified adjusted gross
				family income of at or below two hundred one percent (201%)) of the Federal
				Poverty Level (FPL) and have assets totaling no more than two hundred fifty
				thousand dollars ($250,000), will continue to be eligible for women's health
				services only. Women's health services are defined as: pelvic exams and pap
				tests, sexually transmitted disease testing and treatment (the treatments of
				medical complications occurring from the sexually transmitted disease are not
				covered for this program), family planning counseling/education on various
				methods of birth control, United States Department of Health and Human Services
				approved methods of contraception including sterilization and x-ray services
				related to the sterilization, and drugs (excluding antiretrovirals), supplies,
				or devices related to the women's health services described in this rule when
				they are prescribed by a physician or advanced practice nurse, subject to the
				National Drug Rebate Program requirements.
(2) Uninsured women who do not qualify for
				other benefits, and would lose their MO HealthNet eligibility sixty (60) days
				after the birth of their child or sixty (60) days after a miscarriage, and
				women ages eighteen (18) to fifty-five (55) who have a net family income of at
				or below one hundred eighty-five percent (185%) (which is equivalent to a
				modified adjusted gross family income of at or below two hundred one percent
				(201%)) of the Federal Poverty Level (FPL) and have assets totaling no more
				than two hundred fifty thousand dollars ($250,000), are not required to pay a
				co-payment for women's health services.
(3) The Department of Social Services, MO
				HealthNet Division shall provide for granting an opportunity for a fair hearing
				to any applicant or participant whose claim for benefits under the State-Funded
				Missouri Woman's Health Services Program is denied by the MO HealthNet
				Division. The state hearing officers shall have authority to conduct state
				level hearings of an appeal nature and shall serve as direct representative of
				the director of the MO HealthNet Division.
(4) Reimbursement. Funding of the family
				planning and family planning-related services, pregnancy testing, sexually
				transmitted disease testing and treatment, including pap tests and pelvic
				exams, and follow-up services of the Missouri Woman's Health Services Program
				shall be from general revenue only and none of the funds appropriated may be
				expended to directly or indirectly subsidize abortion services or procedures or
				administrative functions and none of the funds appropriated herein may be paid
				or granted to an organization that provides abortion services. An otherwise
				qualified organization shall not be disqualified from receipt of these funds
				because of its affiliation with an organization that provides abortion services
				provided that the affiliated organization that provides abortion services is
				independent of the qualified organization. An independent affiliate that
				provides abortion services must be separately incorporated from any
				organization that receives these funds. Such services shall be available to
				uninsured women who are at least eighteen (18) to fifty-five (55) years of age
				who have a net family income of at or below one hundred eighty-five percent
				(185%) (which is equivalent to a modified adjusted gross family income for the
				household size of at or below two hundred one percent (201%)) of the Federal
				Poverty Level (FPL) and who is a legal resident of the state.
*Original authority: 208.040, RSMo 1939, amended 1941,
					 1949, 1951, 1953, 1955, 1957, 1973, 1977, 1982, 1983, 1984, 1987, 1994, 1999,
					 2001; 208.201, RSMo 1987, amended 2007; and 660.017, RSMo 1993, amended
					 1995.