MO HealthNet Division

MO HealthNet Managed Care Benefits

MO HealthNet Managed Care is the way you will receive health care. Listed below are some benefits and services you will receive through MO HealthNet Managed Care. Please read the information carefully. If you have any questions, call the MO HealthNet Managed Care Enrollment Helpline at 1-800-348-6627.

Benefits For Everyone

  • Primary Care (from a doctor or nurse) and clinic services
  • Preventive care, including
    • Well checks
    • Mammograms
    • Cancer screenings
  • Family planning services
    • You may use a MO HealthNet Managed Care health plan provider or a MO HealthNet Fee-for-Service approved provider.
  • Maternity Services, including
    • Prenatal visits
    • Delivery
    • Home nurse visits if your hospital stay is less than 48 hours for a normal delivery or 96 hours for a C-Section. The attending doctor and the member must approve a shorter length of stay.
  • Inpatient and outpatient hospital services
  • Behavioral health/Substance abuse services (children in Alternative Care or get Adoption Subsidy get their behavioral health/substance abuse services in MO HealthNet Fee-For-Service)
  • Emergency services
  • Limited durable medical equipment (DME) such as oxygen and wheelchairs
  • Transportation (some children do not get transportation due to their eligibility group)
  • One eye exam every two years for refractive error services related to trauma or treatment of disease/medical condition and one pair of eyeglasses every two years
  • 24-hour access by phone
  • Dental services related to trauma to the mouth, jaw, teeth or other contiguous area as a result of injury

Benefits for Pregnant Women and Children

  • Healthy Children and Youth (HCY) services for those under age 21
    • These services are also called EPSDT. EPSDT stands for early, periodic screening, diagnosis, and treatment
    • Occupational, speech, and physical therapy
    • Testing lead levels in blood
  • Durable medical equipment over what everyone else gets such as crutches, wheelchair accessories, etc.
  • Vision services
  • Dental services
  • Hearing screens and related services
  • Podiatry services
Your MO HealthNet Managed Care health plan will send you a handbook that will tell you all about your MO HealthNet Managed Care benefits. Please read it carefully and keep it in a safe place. If you have questions about your MO HealthNet Managed Care health plan's guidelines, call your MO HealthNet Managed Care health plan.

Pharmacy Benefits:

Pharmacy is part of your benefit in MO HealthNet Managed Care. Starting October 1st, 2009, you will get pharmacy from MO Healthnet Fee-For-Service. Follow the MO HealthNet Fee-for-Services rules about pharmacy. Go to pharmacies that take MO HealthNet Fee-for-Service and use your most recent MO HealthNet Managed Care card.

MO HealthNet Fee-For-Service Benefits

Listed below are some benefits and services you will receive through MO HealthNet Fee-For-Service even when you are in a MO HealthNet Managed Care health plan. MO HealthNet Fee-For-Service, using MO HealthNet Managed Care approved providers, covers these services. Your MO HealthNet Managed Care health plan can help you find a MO HealthNet Managed Care approved provider for that care. Please let your Primary Care Provider know about the care you get. This helps your Primary Care Provider take care of you. You may have to share in the cost for some services. If you have any questions, call the Participant Services Unit at 1-800-392-2161.

  • Therapy services for children in a school Individual Education Plan (IEP) or Individualized Family Service Plan (IFSP). Parents, the school, or the Department of Mental Health may start an IEP or IFSP.
  • Visits by a health worker to see if lead is in your home.
  • Bone marrow and organ transplants.
  • SAFE/CARE exams for abused children.
  • Children who are in Alternative Care or get Adoption Subsidy get mental health care through MO HealthNet Fee-For-Service using MO HealthNet approved providers. These children get their physical health care from their MO HealthNet Managed Care health plan.
  • Community psychiatric rehabilitation. A special program run by the Missouri Department of Mental Health for the seriously mentally ill or seriously emotionally disturbed.
  • Drug and alcohol treatment from a Comprehensive Substance Treatment and Rehabilitation (C-STAR) provider. Call your MO HealthNet Managed Care health plan Member Services for a list of C-STAR providers.
  • Targeted Case Management for mental health services.
  • Abortion - (termination of a pregnancy resulting from rape, incest, or when needed to save the mother's life).

12/03/08