MO HealthNet, Missouri’s Medicaid program, covers doctor visits, hospital and emergency care, prescription drugs, mental health and substance use treatment, maternity care, family planning, durable medical equipment, non-emergency transportation, and long-term care. Dental, vision, hearing, and therapy benefits are included too, but how much you get depends heavily on your age and which eligibility category you fall into. Children under 21 get the broadest coverage; adults get a narrower benefit, with some notable gaps.
Doctor Visits, Hospitals, and Emergency Care
Office visits with physicians and nurse practitioners, inpatient and outpatient hospital services, and emergency room care are covered for every eligibility group.1Missouri DSS. MO HealthNet Managed Care Covered Services
If you’re in a managed care plan, elective hospital admissions need prior authorization. Emergency admissions don’t, but the plan has to be notified within 24 hours or by the next business day. Normal vaginal deliveries are authorized for up to 48 hours of hospital stay, and cesareans up to 96 hours, with extensions when medically justified.2Healthy Blue Missouri. Missouri Quick Reference Card
Prescription Drugs
Prescription drug coverage runs through MO HealthNet’s Preferred Drug List, regardless of whether you’re in managed care or fee-for-service. “Preferred” drugs are generally covered without extra steps. “Non-preferred” drugs may need a prior authorization request from your prescriber.3MyDSS – Missouri. MO HealthNet Pharmacy Program
Prior authorization is specifically required for ADHD medications for children under six, antipsychotics for children under nine, opioids, GLP-1 receptor agonists, growth hormones, hepatitis C treatments, and continuous glucose monitors.3MyDSS – Missouri. MO HealthNet Pharmacy Program
Adults 18 and older pay a small dispensing fee of $0.50 to $2.00 per prescription.1Missouri DSS. MO HealthNet Managed Care Covered Services Most other cost sharing — copays, coinsurance, deductibles — was eliminated effective July 1, 2021, and expansion adults pay no premiums.4Missouri Hospital Association. Hospital Guidance on Medicaid Expansion Enrollment and Reimbursement
Mental Health and Substance Use Treatment
Behavioral health benefits apply to all eligibility groups and include individual, group, and family psychotherapy, crisis intervention, community psychiatric rehabilitation, and applied behavior analysis for autism.5MyDSS – Missouri. Psychotherapy FAQs6Missouri Hospital Association. MO HealthNet Behavioral Health Manual Update Substance use disorder treatment, including C-STAR rehabilitation, is covered.1Missouri DSS. MO HealthNet Managed Care Covered Services
Psychotherapy for anyone age three or older requires precertification after the first 14 hours, with authorizations typically lasting 12 months. Crisis intervention does not require precertification.5MyDSS – Missouri. Psychotherapy FAQs Inpatient psychiatric hospitalization is covered for children in acute care, private psychiatric, and state psychiatric hospitals. For adults ages 21 to 64, inpatient psychiatric care is covered in acute care hospitals and in freestanding psychiatric hospitals of 16 or fewer beds.7Missouri DSS. MO HealthNet Managed Care Policy Statements
Dental Coverage
Dental is one of the areas where benefits split sharply by age. Children under 21, pregnant women, blind individuals, and nursing facility residents get comprehensive dental: preventive cleanings, fillings, extractions, sealants, fluoride treatments, and X-rays.8Missouri DSS. MO HealthNet Dental Provider Education Orthodontic treatment for children is generally excluded unless deemed medically necessary through the EPSDT screening process and approved by the state orthodontic consultant.9American Academy of Pediatric Dentistry. State of Missouri Dental Manual
Adults 21 and older get a narrower benefit. Missouri restored some adult dental coverage in 2016 (cleanings, X-rays, fillings), and routine dental exams for adults were added effective July 1, 2024.10The Beacon. Medicaid Dentists Open Options to People in Missouri11KSHB. Missouri Medicaid Now Covers Routine Dental Exams for Adults Dentures and crowns are still not covered for most adults. After a 2022 reimbursement increase, the network has grown to more than 1,000 participating dental providers.
Vision and Hearing
Eye exams, eyeglasses, and treatment for eye conditions are covered for every group. Children under 21 and pregnant women can get one eye exam per year and one pair of glasses every 24 months. Adults 21 and older get one exam every two years and one pair of glasses every 24 months.1Missouri DSS. MO HealthNet Managed Care Covered Services Contact lenses for routine vision correction are not covered; only therapeutic bandage lenses for specific medical conditions, such as corneal ulcers, qualify. Sunglasses, magnifiers, and eyeglass cases are also excluded.12Cornell Law Institute. 13 CSR 70-40.010 MO HealthNet Optical Program
Hearing coverage expanded recently. Before September 2025, hearing aids were covered only for children under 21, pregnant women, blind individuals, and skilled nursing facility residents.13Cornell Law Institute. 13 CSR 70-45.010 MO HealthNet Hearing Aid Program14Missourinet. New Missouri Law to Provide Hearing Aids, Cochlear Implants to Adults on Medicaid15Healthcare Value Hub. Missouri Expands Hearing Aid Coverage for MO HealthNet Enrollees
Pregnancy, Maternity, and Postpartum Care
Pregnant women on MO HealthNet get full Medicaid benefits throughout pregnancy and for 12 months postpartum, following Missouri’s 2023 extension from the previous 60-day cutoff.16MyDSS – Missouri. MO HealthNet Managed Care Pregnancy Benefits17Medicaid Dental. Missouri Adult Dental Benefit Update Covered services include prenatal visits, ultrasounds, delivery, postnatal care, breastfeeding support, and mental health services.
Managed care plans can add extras for pregnant members, including meal delivery, doula services, breast pumps at no cost, transportation to food pantries and WIC appointments, and reward programs for healthy behaviors.16MyDSS – Missouri. MO HealthNet Managed Care Pregnancy Benefits Prenatal vitamins, folic acid, and vaccinations including flu, Tdap, COVID-19, and RSV are covered through the pharmacy benefit.18Home State Health. Pregnancy Benefits
Children’s Benefits (EPSDT)
Children under 21 get the broadest coverage because of the federally required Early and Periodic Screening, Diagnostic, and Treatment benefit, known in Missouri as the Healthy Children and Youth program. EPSDT requires the state to provide comprehensive preventive care and to cover any Medicaid-eligible service that is medically necessary to treat or correct a condition found at a screening, even if adults wouldn’t ordinarily get that service.19Medicaid.gov. Early and Periodic Screening, Diagnostic, and Treatment
A full EPSDT screening covers a physical exam, developmental history review, immunizations, laboratory tests, lead screening, health education, and vision, hearing, and dental checks. Mental and behavioral health screenings, including autism and maternal depression, are also part of the program, with screenings timed to the Bright Futures/American Academy of Pediatrics periodicity schedule.20Missouri DSS. Bright Futures EPSDT Validated Screening
In practice, EPSDT means children can access services adults may not have, including comprehensive orthodontics for severe malocclusions, physical therapy, occupational therapy, speech therapy, private duty nursing, hearing aid batteries, and diabetes education.1Missouri DSS. MO HealthNet Managed Care Covered Services
Family Planning
All MO HealthNet participants get family planning services. Missouri also runs a separate Uninsured Women’s Health Services program for uninsured women ages 18 to 55 with household incomes up to 201% of the federal poverty level.21MyDSS – Missouri. Eligibility Requirements for MO HealthNet Coverage22Missouri DSS. MO HealthNet Family Planning Provider Education23Missouri DSS. Uninsured Women’s Health Services
Durable Medical Equipment
MO HealthNet covers medically necessary durable medical equipment prescribed by a physician, including wheelchairs and accessories, hospital beds, prosthetics, orthotics, respiratory care equipment, ostomy supplies, and home parenteral nutrition.24MyDSS – Missouri. Durable Medical Equipment Equipment is reviewed annually, and when two items can meet a participant’s needs the program covers only the less expensive option. Items used solely for personal comfort, convenience, or cosmetic purposes, such as air conditioners, home modifications, and whirlpool tubs, aren’t covered.25Cornell Law Institute. 13 CSR 70-60.010 MO HealthNet DME Program
Higher-cost items may require a face-to-face visit with a physician or authorized practitioner within six months before the order, plus precertification from the MO HealthNet Division. If a needed service exceeds standard benefit limits but is medically necessary, you or your provider can file an exception request, reviewed case by case.26MyDSS – Missouri. Exception Process
Non-Emergency Transportation
Non-emergency medical transportation is covered for all participants who have no other way to reach a covered appointment. The state contracts with Medical Transportation Management (MTM) to coordinate rides via public transit, bus tokens, vans, taxis, rideshares, and even flights when needed.27MyDSS – Missouri. MO HealthNet Transportation Participants can also receive mileage reimbursement at $0.725 per mile for using a personal vehicle or riding with someone they know.28MTM Health. MTM Missouri
Rides need to be scheduled at least two days ahead in urban counties and three days ahead in rural counties, though urgent trips can be arranged around the clock. Scheduling runs by phone, through the MTM Link app, or online. Transportation isn’t available for pharmacy pickups (unless for a scheduled vaccination), certain developmental disability waiver services, or services provided in the participant’s home.28MTM Health. MTM Missouri
Telehealth
Services delivered by telehealth are covered when they meet the same standard of care as in-person visits. Any Missouri-licensed provider enrolled with MO HealthNet may deliver telehealth within their scope of practice, and providers may be physically located in a bordering state as long as they hold a Missouri license. Store-and-forward asynchronous technology is also permitted.29MyDSS – Missouri. Telemedicine Bulletin30MyDSS – Missouri. MO HealthNet Telemedicine
Long-Term Care and Home-Based Waivers
Nursing facility care is covered for eligible participants, who must contribute nearly all of their income toward the cost of care. Residents keep a $50 monthly personal needs allowance plus amounts for health insurance premiums and, where applicable, a spousal allowance for a non-applicant spouse.31MyDSS – Missouri. Apply for MO HealthNet Asset limits are strict: $6,068.80 for a single applicant as of 2026, with a community spouse allowed to retain up to $162,660. A five-year look-back period applies to asset transfers.32Medicaid Planning Assistance. Medicaid Eligibility in Missouri
As an alternative to institutional care, Missouri runs 11 active home- and community-based waiver programs through the Department of Health and Senior Services and the Department of Mental Health. Waiver services can include adult day care, personal care assistance, respite care, homemaker services, home-delivered meals, environmental modifications, supported employment, and independent living support.33MyDSS – Missouri. Waiver Programs34Medicaid.gov. Missouri Waiver Descriptions Unlike nursing facility coverage, which is an entitlement, waiver slots are limited and may have waiting lists.32Medicaid Planning Assistance. Medicaid Eligibility in Missouri Missouri also participates in the Program of All-Inclusive Care for the Elderly (PACE), which combines health and social services to help older adults remain at home instead of entering a nursing facility.31MyDSS – Missouri. Apply for MO HealthNet
What MO HealthNet Doesn’t Cover
The program is broad, but there are real gaps:
- Dentures and crowns remain excluded for most adults.10The Beacon. Medicaid Dentists Open Options to People in Missouri
- Routine contact lenses aren’t covered; only therapeutic bandage lenses for specific conditions qualify.12Cornell Law Institute. 13 CSR 70-40.010 MO HealthNet Optical Program
- Physical, speech, and occupational therapy are covered for children and pregnant women but not for adults 21 and older.1Missouri DSS. MO HealthNet Managed Care Covered Services
- Durable medical equipment used only for personal comfort, education, hygiene, safety, or cosmetic purposes is excluded.25Cornell Law Institute. 13 CSR 70-60.010 MO HealthNet DME Program
- Chiropractic care, acupuncture, and physical therapy for chronic pain management were eliminated effective July 1, 2026, as part of a state budget reduction for fiscal year 2027.35Missouri Independent. Missouri Medicaid Will No Longer Cover Chiropractic Care After Budget Cuts36KFVS12. Missouri Medicaid Will No Longer Cover Trips to the Chiropractor Starting July
When a needed service exceeds standard benefit limits but is medically necessary, participants or providers can submit an exception request to the MO HealthNet Division for case-by-case review. No exceptions are granted for items specifically prohibited by state or federal law.26MyDSS – Missouri. Exception Process