Understanding Medicaid: Coverage, Eligibility and Services

Missouri

• Anthem Healthy Blue
• Home State Health
• UnitedHealthcare Community

Oklahoma

• Oklahoma Complete Health
• Aetna Better Health – Oklahoma
• Humana Healthy Horizons

Arkansas (PASSE Managed Medicaid Only)

• Arkansas Total Care
• CareSource
• Empower Healthcare Solutions
• Summit Community Care

Kansas (includes Mercy Joplin, Carthage, Columbus and Springfield are clinic providers)

• Aetna Better Health of KS
• Anthem Healthy Blue
• United Healthcare Community Plan of KS
• Sunflower Health (only includes Joplin/Carthage area in MO)

No. Medicare is designed for people who are over 65. Medicaid is designed for people of all ages who need health care. This includes people under 65 with disabilities as well as those who may have limited income and resources.

You must first determine if you qualify for Medicaid and then apply for it. Each state has their own standards for eligibility. You can find those in the state-specific information below. 

Missouri

• November 1st – December 15th, every year

Oklahoma

• Open enrollment occurs every 12 months.

Arkansas PASSE

• October 1st – October 31st, every year

Kansas

• If your Open Enrollment is in January, you will get your packet in October 2024. The enrollment period lasts until March 4, 2025.  KanCare members will receive an Annual Open Enrollment packet in the mail 60 days prior to their open enrollment date. If your Open Enrollment is later, you will get your packet in the following months. The packet will tell you which Managed Care Organization (MCO) you are enrolled in. You can stay with your current MCO or choose a new one.

Each state has its own online application portal. You can find them in the state-specific information below.
 

In addition, if patients need assistance in determining eligibility and applying for Medicaid of their state of residence, contact Eligibility Services Call Center - 844-764-6850 (option 3).

A primary care physician, also called a PCP, is a doctor who takes care of you and helps you stay healthy. Having access to a PCP improves quality of life, especially for vulnerable patients. Most Medicaid programs require or highly encourage patients to select a PCP upon enrollment. See state-specific information below.
 

For a list of Mercy Primary Care Providers, visit our website under the "Find a Provider" section. Plan provider directories are also available on each plan’s website to help in this decision.

Medicaid covers essential health services, meaning those services that are necessary to preserve life. Medicaid covers things like emergency medical, preventive care, maternity services, inpatient/outpatient services, Healthy Children and Youth (HCY) and services such as physical exams and immunizations (shots), behavioral health and substance use disorders. It doesn’t cover services like cosmetic surgery. In some states, Medicaid also covers dental services. 

Depending on your state, age, income, health and individual needs, people who may be eligible for Medicaid include:

• Disabled people, including blind or visually impaired people
• People who are 65 or older
• Pregnant women
• Families where one or both parents are absent, disabled or unemployed
• People under 21 in foster care
• People living in nursing homes
• People who need home- or community-based medical services
• Women with breast or cervical cancer
• People eligible for Supplemental Security Income (SSI) benefits
• Children enrolled in the Special Health Care Needs program
• People in the Adult Expansion Program, aged 19-64 with limited income, not receiving SSI, not pregnant and not eligible for Medicare

Missouri

• Patients may change Managed Medicaid plans for any reason during the first 90 days of enrollment.
• Once the 90-day change period ends, the member is locked into the MO HealthNet Managed Care health plan for one year unless they have “just cause” to ask for a change and it is approved. Examples of “just cause” include:
• The member’s Primary Care Provider is no longer in their MO HealthNet Managed Care health plan (but is with another plan)
• The member needs to transfer to another MO HealthNet Managed Care health plan to ensure continuity of care
• There has been an act of cultural insensitivity that negatively impacts the member’s ability to get care and cannot be resolved by the MO HealthNet Managed Care health plan
• A child is in the state’s custody (foster care) or receives adoption subsidy (these children can change health plans as often as necessary)

Oklahoma

• Patients may change Managed Medicaid plans for any reason during the first 90 days of enrollment. - From my review, OK has not specified special enrollment/just cause reasons yet.

Arkansas PASSE

• If you would like to change your PASSE, you can do that within the first 90 days of being assigned to a PASSE.
• After 90 days, you can only change during the next 12 months for cause. Here are reasons you can change:
  • You move out of state.
  • You do not have access to covered services.
  • There are no providers who know how to deal with your health care needs.
  • You get poor quality care.
  • DHS sanctions CareSource PASSE.
  • Other reasons determined by DHS.

Kansas

• You have until the Choice Period End Date on the enrollment form to change plans. This date is 90 days from initial enrollment.
• Occasionally, a member will have a “good cause” reason that may allow them to change in the middle of the year:
  • You live in a nursing home that no longer accepts your plan
  • You do not have access to covered services or providers
  • You need a certain medical treatment (specialist or specialty care) that is not available in your health plan

It depends on the plan you choose. You’ll need to check if your doctor is in the plan’s network. Plans often charge more for out-of-network doctors or may not cover them at all.

You can still get coverage, possibly through Medicare or through the Affordable Care Act (ACA).
 

Visit Mercy’s Medicare page here.

Visit the ACA Exchange page here.