Missouri

Missouri Medicaid and the new work rules

MO HealthNet — Adult Expansion Group (AEG) for adults 19–64 is run by Missouri Department of Social Services (DSS) — MO HealthNet Division (MHD) administers the program; the Family Support Division (FSD) decides eligibility. Missouri expanded Medicaid on Eligibility began July 1, 2021 under the constitution; the Family Support Division actually began processing Adult Expansion Group applications on October 1, 2021, after litigation, which is why the new federal work requirement reaches this state — and why what you do before January 1, 2027 matters.

Work rules start January 1, 2027 Medicaid expanded 1,255,035 enrolled 342,618 in the expansion group

Start here

From January 1, 2027, most adults have to show 80 hours a month

The requirement applies to adults aged 19 to 64 covered through Medicaid expansion — around 342,618 people in Missouri. It is not only about paid work: study, job training, volunteering and a mix of them all count , and earning at least $580 a month satisfies it on its own.

DSS says it will verify through ex parte processes first — existing electronic data sources, with real-time income and work-hours integrations being built — and that where it cannot verify something, 'it will be the responsibility of the participant to provide the necessary documentation.' DSS must build a system to track 80 monthly hours for roughly 300,000 to 360,000 adults by December 31, 2026. If FSD cannot confirm that you met the requirement or that it does not apply to you, it sends a notice of noncompliance and you have 35 calendar days from the date on that notice to respond; existing coverage stays active during those 35 days while FSD reviews what you send. If you do not respond, or what you send does not establish compliance or an exclusion, FSD can deny the application or end coverage, and must send a written decision explaining your appeal rights.

If your hours swing from month to month, say so. The rule is written per month, which is the wrong shape for farm and fishing work, construction, tourism and seasonal retail — a good month and a dead month average out to a living, but the dead month is the one that fails. Federal law has a provision for exactly this: a seasonal worker can satisfy the requirement using their average monthly income over the previous six months instead of hours worked in the month being checked. It is at 42 CFR 435.552(a)(7), and the law defines who counts as seasonal by pointing at the tax code rather than listing jobs, so do not decide for yourself that it misses you. If your work is seasonal or your hours are irregular, tell the state that when you report, and ask for the six-month average to be used.

2025-07-04 · already happened

H.R. 1 (P.L. 119-21) signed into law, creating the federal community engagement requirement for expansion adults

2026-01-05 · already happened

HJR 154 introduced in the Missouri House, proposing to write work requirements into the state constitution and repeal subsections 4 and 5 of Article IV, Section 36(c)

2026-02-19 · already happened

House passes HJR 154, 99-48 on party lines, sending it to the Senate

2026-03-04 · already happened

DSS Director Jess Bax tells the Senate Appropriations Committee the federal timeline is 'extremely aggressive' and that CMS has not yet issued detailed guidance; the department's request to implement H.R. 1 totals $294.6 million, including $35 million in state general revenue

2026-06-03 · already happened

CMS interim final rule (CMS-2454-IFC) published in the Federal Register; it took effect July 31, 2026

2026-06 · already happened

DSS mails H.R.1 non-citizen eligibility notices

2026-05-15 · already happened

Missouri's 2026 regular session ends with HJR 154 never voted on in the Senate; the Medicaid work requirement amendment does not reach the November 2026 ballot

2026-08-24 · already happened

DSS begins mailing the Adult Expansion Group Community Engagement Outreach Notice to more than 300,000 participants, continuing in batches through September

2026-09 · already happened

DSS publishes its Community Engagement Requirements FAQ and public screening tool, and holds a participant town hall; DSS tells the Missouri Independent it has 'not yet finalized whether Missouri will use self-attestation during 2027' or what screening method it will use for the medically frail exclusion

2026-10-01 · already happened

H.R.1 non-citizen eligibility restrictions take effect for MO HealthNet and CHIP

2026-12-31

Deadline for the state's systems: six-month redeterminations for the Adult Expansion Group begin, and DSS must have its community engagement tracking system live

2027-01-01

Community Engagement Requirements begin for the Adult Expansion Group; retroactive coverage drops to one month for AEG and two months for everyone else

2028-01-01

Federal rules tighten documentation: states may accept only one self-attestation per enrollment period, so 2027's lighter proof standards do not carry forward

2028-10

Cost-sharing begins for Adult Expansion Group members with income above 100% of the poverty level

You do not have to prove anything if any of these describe you

Exemptions are meant to be applied by the state automatically from records it already holds, but records are imperfect. If one of these fits you and you still get asked to report hours, say so and ask them to check — don't assume the notice is right.

You are pregnant, or you are receiving MO HealthNet postpartum coverage

You have Medicare Part A or Part B

You are a former foster youth under age 26 who meets the federal definition

You meet the federal definition of an American Indian or Alaska Native

The Department of Veterans Affairs has rated you 100% disabled, temporarily or permanently

You are medically frail, or you have special medical needs that greatly limit your ability to meet the requirements

You are taking part in a drug or alcohol treatment and rehabilitation program

You are a parent, guardian or caretaker of a dependent child age 13 or younger

You are a family caregiver for a person with a disability and you meet the caregiver requirements

You are meeting Temporary Assistance work requirements

Your household gets SNAP and you are subject to a SNAP work requirement

You are in jail or prison — and if you were in jail or prison at any point in the three months before the month FSD checks, FSD treats you as having met the requirement for that month

Income limits

What you can earn and still qualify

Monthly income, before tax, for the whole household. These are the state's own published figures, which is what its caseworkers actually apply. If you are close to a line, apply anyway — some income does not count, and only the agency can run the calculation for your situation.

Adults 19 to 64133% of the poverty line

1 person: $1,836
2 people: $2,489
3 people: $3,142
4 people: $3,795
5 people: $4,449
6 people: $5,102
7 people: $5,755
8 people: $6,408
9 people: $7,061
10 people: $7,715
11 people: $8,368

Parents and caretakers

1 person: $141
2 people: $241
3 people: $301
4 people: $353
5 people: $400
6 people: $445
7 people: $490
8 people: $532
9 people: $574
10 people: $616
11 people: $658

Pregnant196% of the poverty line

1 person: $2,674
2 people: $3,625
3 people: $4,577
4 people: $5,528
5 people: $6,479
6 people: $7,431
7 people: $8,382
8 people: $9,334
9 people: $10,285
10 people: $11,236
11 people: $12,188

Source: DSS Family Support Division, Family MO HealthNet (MAGI) Manual, section 18.2.1 / MAGI Appendix A, 'MAGI Income max with 5% — CHIP 75, UWHS, MPW POV, MHK, & AEG — FPL Included and CHIP premium amounts,' table effective 7/1/2026 through 3/31/2027 (revised 04/26). Cross-checked against the consumer-facing DSS 'Benefit Program Income Limits' chart, as of 04/01/2026. A note on precision: Missouri publishes two different income limits for expansion adults and they do not match. We publish the state figure.

January 1, 2027

Two other changes land on the same day

Renewals get more frequent, and back-dated coverage gets shorter.

Renewals every six months From January 2027, Adult Expansion Group members renew every six months instead of once a year, and DSS will check community engagement compliance as part of that renewal — so the paperwork that can cost someone coverage arrives twice as often. Everyone in other MO HealthNet coverage groups stays on an annual renewal.

Back-dated coverage is changing on January 1 One month of retroactive coverage for Adult Expansion Group adults; two months for everyone else, including children, parents, pregnant people and the aged, blind and disabled. DSS states this in its own words on its H.R.1 participant page: 'Starting January 2027, retroactive coverage will be limited to 1 month for AEG and 2 months for other coverage groups, such as those with disabilities and children.' If you have unpaid medical bills, applying sooner covers more of them.

P.L. 119-21 §71112, amending 42 U.S.C. §1396a(a)(34). Applies to applications submitted on or after January 1, 2027.

Do this now

Update your address and phone number first. Everything about the new rules arrives by mail, and a stale address is the most common reason people lose coverage they are still entitled to. Then check whether an exemption applies to you.

Apply, renew or update details Apply for MO HealthNet (mydss.mo.gov/healthcare/apply) There are four ways to apply and you do not need to pick your program first: online through the state portal, by phone at 855-373-9994, or by downloading and printing the paper application (also available in Spanish) and returning it by upload at mydssupload.mo.gov, by fax to 573-526-9400, by mail to the Jefferson City address, or in person at a Family Support Division Resource Center. Talk to a person 855-373-4636 Family Support Division Information Center — general questions, report an address or income change, ask for a translator Apply for MO HealthNet by phone 855-373-9994 MO HealthNet Constituent Services 800-392-2161 questions about covered services and your card (have your MO HealthNet ID number ready)

About the phone numbers: One number does almost everything and the others are narrower than they sound. 855-373-4636 is the Family Support Division Information Center — use it for anything about your eligibility, your address, your income or your renewal, and ask for a translator if you need one. 800-392-2161 is MO HealthNet Constituent Services and handles covered services and cards, not eligibility, and it will ask for the ID number on your MO HealthNet card. The 855-684-9242 text line cannot discuss your case at all. If you are in the Show Me Healthy Kids plan you cannot switch plans, so the enrollment helpline cannot help with that.

Deaf, hard of hearing or speech-impaired: Relay Missouri 711, or 800-735-2966 (text phone) and 800-735-2466 (voice); call 800-735-2466 for American Sign Language.

EnglishSpanish

MO HealthNet's application, its Managed Care and Fee-For-Service guides, and its community engagement flyer are published in English and Spanish. For any other language, free interpreters are available by phone at no cost to you: call the Family Support Division Information Center at 855-373-4636 and ask for a translator. If you are deaf, hard of hearing, deaf-blind or have difficulty speaking, call Relay Missouri at 711, or 800-735-2966 for a text phone and 800-735-2466 for voice; call 800-735-2466 for American Sign Language. Your health plan also provides interpreters at no cost.

If a letter arrives

Most people who lose coverage lose it over paperwork, not eligibility

Nationally, most people who lose Medicaid lose it over paperwork rather than because they stopped qualifying. From January 1, 2027 that matters more, not less.

Missouri Department of Social Services (DSS) — MO HealthNet Division (MHD) administers the program; the Family Support Division (FSD) decides eligibility · Notice of action

NOTICE OF ELIGIBILITY DETERMINATION

Case number: ███████
Date of this notice: 1January 12, 2027

Our records do not show that you met the community engagement requirement for the reporting period.

2If you believe this is incorrect, or if an exemption applies to you, contact us on or before February 11, 2027.

3Coverage for other members of your household is not affected by this notice.

The clock starts on this date. Not the day it reached you. Assume you have less time than it feels like.

"Our records do not show" is not the same as "you did not".The state is matching against databases that are often out of date. If you worked those hours, or an exemption fits you, say so — call 855-373-4636.

Your children's coverage is separate. The work requirement does not apply to them. A notice about you does not end their coverage.

You can ask for a fair hearing. It's free, you don't need a lawyer, and asking can keep your coverage running while it's reviewed.

Know your state

What the federal data says about coverage here

Public federal data describes how each state runs its program. Almost all of it is written for policy analysts. Here is what those numbers mean if you are the person enrolled.

How care is delivered

Managed care

Coverage here runs through private health plans rather than the state paying providers directly. You pick a plan, and your plan decides your network.

Check your doctor is in the plan before you choose it.

Common questions

Questions people ask about this

Do the new Medicaid work rules apply to me in Missouri?

They apply to adults aged 19 to 64 who are covered through Medicaid expansion — about 342,618 people in Missouri. Children, people over 65, and most people covered on grounds of disability or pregnancy are not in that group. There is also a long list of exemptions.

How many hours a month do I have to work?

80 hours a month. Work is not the only way to meet it — study, job training, volunteering and a combination of these count too, and earning at least $580 a month also satisfies it.

Who is exempt from the work requirement in Missouri?

Exemptions include: You are pregnant, or you are receiving MO HealthNet postpartum coverage; You have Medicare Part A or Part B; You are a former foster youth under age 26 who meets the federal definition; You meet the federal definition of an American Indian or Alaska Native; The Department of Veterans Affairs has rated you 100% disabled, temporarily or permanently; You are medically frail, or you have special medical needs that greatly limit your ability to meet the requirements; You are taking part in a drug or alcohol treatment and rehabilitation program; You are a parent, guardian or caretaker of a dependent child age 13 or younger.

When do the Missouri work rules start?

January 1, 2027. From January 2027, Adult Expansion Group members renew every six months instead of once a year, and DSS will check community engagement compliance as part of that renewal — so the paperwork that can cost someone coverage arrives twice as often. Everyone in other MO HealthNet coverage groups stays on an annual renewal. Keeping your address and phone number current with the state is the single most important thing to do before then, because everything arrives by mail.

What is the income limit for Missouri Medicaid?

For adults 19 to 64, about $1,836 a month for one person and $8,368 for a household of 11.

How do I apply for MO HealthNet — Adult Expansion Group (AEG) for adults 19–64?

Online at Apply for MO HealthNet (mydss.mo.gov/healthcare/apply), or by phone on 855-373-4636. It is free and there is no open-enrollment window — you can apply at any time of year.

How often do I have to renew Missouri Medicaid?

Adults covered through Medicaid expansion move from a yearly renewal to one every six months starting with renewals due on or after January 1, 2027. Children, people over 65 and most people covered on grounds of disability stay on yearly renewals. Keep your address and phone number current so the renewal notice reaches you, and answer it before the date on the letter — most people who lose coverage lose it over paperwork.

Other states

Guides for neighboring states

The rules change completely at the state line. If you moved recently, or you're helping family somewhere else, start with their state rather than this one.

ArkansasWork rules are already being enforced IllinoisThe new work rules IowaThe new work rules KansasWho actually qualifies KentuckyThe new work rules NebraskaThe new work rules OklahomaThe new work rules TennesseeWho the work rules reach

See all 50 states and Washington, D.C. on the map →

Missouri will not ask you to prove 80 hours every single month.

The Family Support Division checks one qualifying month — the month right before you apply, or any one month since your last renewal — and work, self-employment, volunteering through a nonprofit or public agency, a work program, half-time school, a mix of those, or $580 in income for the month all count. What Missouri will not do is excuse a bad month: the state has declined the optional hardship exception, so a layoff or a family emergency does not cover you on its own. And starting in January 2027 your renewal comes every six months instead of once a year. The single most useful thing you can do today is make sure the Family Support Division has your current address, phone and email at mydss.mo.gov, then keep a record of your hours or your income each month.

Updating your address takes two minutes and protects everything else. Do that first, then check the exemption list above.

Go to Apply for MO HealthNet (mydss.mo.gov/healthcare/apply) →