1850.010.00 Legal Basis – DSS Manuals

IM-105 December 22, 2023 ; IM-135 August 28, 2019

Federal regulation 42 CFR 435.223 along with Senate Bill 588 from the Missouri 80th General Assembly allows Title XIX benefits to pregnant women who would be eligible for AFDC cash benefits as if in fact the child had already been born. This program became effective in Missouri August 13, 1980.

The Consolidated Omnibus Budget Reconciliation Act (COBRA) P.L. No. 99-272 provides for Title XIX eligibility for pregnant women who would be eligible for AFDC based on the income and resource requirements and for 60-day postpartum Title XIX coverage for all pregnant women who received benefits under the MO HealthNet for Pregnant Women program (MPW). Deprived of Parental Support was removed as an eligibility factor for the MO HealthNet for Pregnant Women program. House Bill No. 518 enacted by the 84th General Assembly mandates these changes in RSMo 208.151 . An emergency clause made this part of the law effective upon passage and approval. House Bill No. 518 was signed into law July 7, 1987.

RSMo 208.151, beginning January 1, 1988, provides restricted MO HealthNet benefits, including 60-day postpartum benefits, for pregnant women who have family income less than 100% of the federal poverty level.

Senate Bill No. 765 enacted by the 85th General Assembly mandates changes in RSMo 208.151. Beginning July 1, 1990, Missouri provides MO HealthNet benefits, including 60-day postpartum benefits for pregnant women who have family income less than 133% of the federal poverty level, and provides continuous eligibility for pregnant women determined eligible under the MO HealthNet for Pregnant Women program when subsequent changes in income cause the claimant to become ineligible. The bill also eliminates resources as an eligibility factor.

HB 564 enacted changes effective January 1, 1994, providing Title XIX coverage to pregnant women with family income less than 185% of the federal poverty level.

Effective February 1, 1999 Missouri began providing two years of coverage for women’s health services to uninsured women losing MO HealthNet for Pregnant Women (MPW) eligibility 60 days after their pregnancy ends. To be eligible for the extended women’s health services (EWHS), MPW eligibility must have ended on or after January 31, 1999. A Medicaid waiver under Section 1115 of the Social Security Act authorizes this coverage.

Effective July 1, 2002 Missouri House Bill 1111 reduced the coverage for women’s health services to 12 months.

Effective January 1, 2014, the Patient Protection and Affordable Care Act (PPACA) of 2010 requires Family MO HealthNet programs to use Modified Adjusted Gross Income (MAGI) methodology. To reflect the PPACA requirement to remove income disregards from all Family MO HealthNet programs, the Federal Poverty Level (FPL) increased for MPW from 185% to 196%.

Federal regulation 42 CFR §435.116 replaced 42 CFR §435.223 effective July 15, 2013. The amendment implements sections 1902(a)(10)(A)(i)(III) and (IV); 1902(a)(10)(A)(ii)(I), (IV), and (IX); and 1931(b) and (d) of the Social Security Act.

Sections 9812 and 9822 of the American Rescue Plan Act of 2021 (ARP) (Pub. L. 117-2) gave States the option to provide 12 months of extended postpartum coverage to pregnant individuals enrolled in Medicaid and CHIP. Senate Bills 45 and 106 were passed by the 102 nd General Assembly and signed by the Governor on July 6, 2023 implementing this change in Missouri. The EWHS program is being discontinued with the implementation of 12 month postpartum coverage.