Attachment 1 - MO HealthNet Managed Care Eligibility Groups.pdf
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- Attached to
- MO HealthNet Managed Care Program
- Solicitation number
- 300000262314351
- Issued by
- Missouri
About this file
This document is an attachment to a Missouri Department of Health and Senior Services contract opportunity that outlines MO HealthNet managed care eligibility groups across five regional service areas: Western, Eastern, Central, and Southwestern regions. The file presents estimated monthly eligibility counts for multiple eligibility groups across State Fiscal Years 2023, 2024, and 2025, organized by eligibility category codes and medical eligibility (ME) codes. The primary eligibility groups detailed include Parents and Caretakers under MO HealthNet for Families, Children and Newborns under various funding mechanisms (Poverty-based, CHIP Fund, Health Initiative Fund), Show Me Healthy Babies (SMHB) Newborns at 186% of Federal Poverty Level, and Adult Expansion Group (AEG) members at less than 138% of Federal Poverty Level ages 19-64. Eligibility numbers reflect declining trends across the three-year period, with Western Region Parents and Caretakers declining from 176,417 to 126,637; Eastern Region from 240,959 to 171,632; Central Region from 202,959 to 148,371; and Southwestern Region from 146,574 to 107,408. Adult Expansion Group membership shows variable trends, with increases in some regions and decreases in others.
The document indicates that estimated figures represent average monthly eligibility counts sourced from Missouri Medicaid regional eligibility data and managed care data. Historical ME Codes 71 and 72 are noted as no longer in use, with this population transitioning to ME Code 4M. The attachment was revised in January 2026 as Amendment #1 to the contract opportunity, suggesting ongoing updates to eligibility projections and regional service delivery requirements for Missouri's managed care program.
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Other files
| File | Type | Posted |
|---|---|---|
| MO HealthNet Managed Care Program - Amendment 01.docx | DOCX document | |
| Attachment 8 - Pricing Page - Specialty Plan.pdf | ||
| Attachment 9 - Actuarial Memorandum Appendices.xlsx | XLSX spreadsheet | |
| Attachment 7 - Pricing Page - General Plan.pdf | ||
| Attachment 4 - Actuarial Memorandum.pdf | ||
| Attachment 5 - Business Associate Agreement.docx | DOCX document | |
| Attachment 6 - Federal Funds Requirements.docx | DOCX document | |
| Attachment 3 - DMH Decision Tree.docx | DOCX document | |
| MO HealthNet Managed Care Program.docx | DOCX document | |
| Attachment 2 - FQHCs, RHCs, CMHCs, Safety Net Hospitals, Family Planning, & STI Providers.xlsx | XLSX spreadsheet |
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Group
COA 1 ME
Codes ME Code Description State Fiscal
Year 2023 State Fiscal Year 2024
State Fiscal Year 2025
Parents and 176,417 154,999 126,637 Caretakers, MO HealthNet For Families Children, Newborns 05 MO HealthNet for Families – Adult
06 MO HealthNet for Families – Child MO HealthNet for Kids - Poverty
40 MO HealthNet for Kids - Poverty 62 MO HealthNet for Kids - Health Initiative Fund
4M MO HealthNet for Kids - CHIP Fund Newborns
60 Newborns (Eligibility Only) 6S SMHB Newborns <186% FPL
MO HealthNet Managed Care and Related Eligibles Groups MO HealthNet Managed Care Eligibles – Western Region
Eligibility Criteria Estimated Numbers
Amendment #1
Page 1 Revised January 2026
COA 2 ME
Codes ME Code Description State Fiscal
Year 2023 State Fiscal Year 2024
State Fiscal Year 2025
Pregnant Women 8,282 7,692 8,010 MO HealthNet for Pregnant Women
18 MO HealthNet for Pregnant Women 43 Preg Women-60 days Postpartum - MAF 44 Preg Women-60 days Poverty 45 Preg Women-Poverty 61 Pregnant Woman Poverty 133% -185% FPL
– HIF
95 SMHB* Pregnant Women-income above
196% and up to 300% 96 SMHB* Unborn Child income 0% to 300% 98 SMHB* Post-Partum
*SMHB (Show Me Healthy Babies)
MO HealthNet Managed Care and Related Eligibles Groups MO HealthNet Managed Care Eligibles – Western Region
Eligibility Criteria Estimated Numbers
Page 2 Revised January 2026
COA 4 ME
Codes ME Code Description State Fiscal
Year 2023 State Fiscal Year 2024
State Fiscal Year 2025
MO HealthNet 10,544 9,786 8,271 Children in Care DSS Division of Family Services and Custody and 07 Foster Care – IV - E Adoption Subsidy 37 Title XIX-FFP/HDN
38 Independent Foster Care Children -Age 18 up to age 26
08 CWS-FC
66 Child Welfare – HIF 0F Foster Care – Title IV-E (State Only - Funded)
0H Foster Care – Non-Title IV-E & IMD (Non- Waiver) (State Only - Funded) Adoption Subsidy
36 Adoption Subsidy-FFP 56 Adoption Subsidy- IV - E Eligible 57 Adoption Subsidy – CWS
5A Adoption/Guardianship Subsidy Title IV-E (State Only – Funded)
5C Adoption/Guardianship Subsidy - Non-Title IV- E & IMD (Non-Waiver) (State Only - Funded) DSS Division of Youth Services
29 Div of Youth Svcs FYS-FC
52 DYS-GR
50 DYS-Poverty
68 DYS - HIF
MO HealthNet Managed Care and Related Eligibles Groups MO HealthNet Managed Care Eligibles – Western Region
Eligibility Criteria Estimated Numbers
Page 3 Revised January 2026
COA 5 ME
Codes ME Code Description State Fiscal
Year 2023 State Fiscal Year 2024
State Fiscal Year 2025
SCHIP 6,848 10,463 14,447
9S
MO HealthNet For Kids (SCHIP) CHIP 151-185% Age 1-18 CHIP 186-225% Age 0-18 CHIP 226-300% Age 0-18 SMHB* Newborns SMHB* Newborns >=186% FPL%
*SMHB (Show Me Healthy Babies)
Eligibility Criteria Estimated Numbers
MO HealthNet Managed Care and Related Eligibles Groups MO HealthNet Managed Care Eligibles – Western Region
Page 4 Revised January 2026
COA 6 ME
Codes ME Code Description State Fiscal
Year 2023 State Fiscal Year 2024
State Fiscal Year 2025
AEG 63,233 72,237 73,995
Adult Expansion Group
E2 Adult Expansion Group < 138% Age 19-64
Source:
• COA 1, 2, 5, & 6: Missouri Medicaid West Region Eligibility Data.
• COA 4: Missouri Medicaid West Region Managed Care Data.
Note:
• The estimated numbers above are an average monthly eligibility count.
• ME Codes 71 and 72 are no longer used as this population has moved to ME Code 4M.
Eligibility Criteria Estimated Numbers
MO HealthNet Managed Care and Related Eligibles Groups MO HealthNet Managed Care Eligibles – Western Region
Page 5 Revised January 2026
Codes ME Code Description State Fiscal
Year 2023 State Fiscal Year 2024
State Fiscal Year 2025
Parents and 240,959 213,902 171,632 Caretakers, MO HealthNet For Families Children, Newborns 05 MO HealthNet for Families – Adult
06 MO HealthNet for Families – Child MO HealthNet for Kids - Poverty
40 MO HealthNet for Kids - Poverty 62 MO HealthNet for Kids - Health Initiative Fund
4M MO HealthNet for Kids - CHIP Fund Newborns
60 Newborns (Eligibility Only) 6S SMHB Newborns <186% FPL
MO HealthNet Managed Care and Related Eligibles Groups MO HealthNet Managed Care Eligibles – Eastern Region
Eligibility Criteria Estimated Numbers
Page 6 Revised January 2026
Codes ME Code Description State Fiscal
Year 2023 State Fiscal Year 2024
State Fiscal Year 2025
Pregnant Women 10,879 9,678 10,225 MO HealthNet for Pregnant Women
18 MO HealthNet for Pregnant Women 43 Preg Women-60 days Postpartum - MAF 44 Preg Women-60 days Poverty 45 Preg Women-Poverty 61 Pregnant Woman Poverty 133% -185% FPL
– HIF
95 SMHB* Pregnant Women-income above
196% and up to 300% 96 SMHB* Unborn Child income 0% to 300% 98 SMHB* Post-Partum
*SMHB (Show Me Healthy Babies)
MO HealthNet Managed Care and Related Eligibles Groups MO HealthNet Managed Care Eligibles – Eastern Region
Eligibility Criteria Estimated Numbers
Page 7 Revised January 2026
Codes ME Code Description State Fiscal
Year 2023 State Fiscal Year 2024
State Fiscal Year 2025
MO HealthNet 14,466 13,593 11,571 Children in Care DSS Division of Family Services and Custody and 07 Foster Care – IV - E Adoption Subsidy 37 Title XIX-FFP/HDN
38 Independent Foster Care Children -Age 18 up to age 26
08 CWS-FC
66 Child Welfare – HIF 0F Foster Care – Title IV-E (State Only - Funded)
0H Foster Care – Non-Title IV-E & IMD (Non- Waiver) (State Only - Funded) Adoption Subsidy
36 Adoption Subsidy-FFP 56 Adoption Subsidy- IV - E Eligible 57 Adoption Subsidy – CWS
5A Adoption/Guardianship Subsidy Title IV-E (State Only – Funded)
5C Adoption/Guardianship Subsidy - Non-Title IV- E & IMD (Non-Waiver) (State Only - Funded) DSS Division of Youth Services
29 Div of Youth Svcs FYS-FC
52 DYS-GR
50 DYS-Poverty
68 DYS - HIF
MO HealthNet Managed Care and Related Eligibles Groups MO HealthNet Managed Care Eligibles – Eastern Region
Eligibility Criteria Estimated Numbers
Page 8 Revised January 2026
Codes ME Code Description State Fiscal
Year 2023 State Fiscal Year 2024
State Fiscal Year 2025
SCHIP 8,118 13,222 19,114
MO HealthNet For Kids (SCHIP)
73 CHIP 151-185% Age 1-18 74 CHIP 186-225% Age 0-18 75 CHIP 226-300% Age 0-18 97 SMHB* Newborns 9S SMHB* Newborns >=186% FPL%
*SMHB (Show Me Healthy Babies)
MO HealthNet Managed Care Eligibles – Eastern Region
Eligibility Criteria Estimated Numbers
MO HealthNet Managed Care and Related Eligibles Groups
Page 9 Revised January 2026
Codes ME Code Description State Fiscal
Year 2023 State Fiscal Year 2024
State Fiscal Year 2025
AEG 102,875 111,279 109,951
Adult Expansion Group
E2 Adult Expansion Group < 138% Age 19-64
Source:
• COA 1, 2, 5, & 6: Missouri Medicaid East Region Eligibility Data.
• COA 4: Missouri Medicaid East Region Managed Care Data.
Note:
• The estimated numbers above are an average monthly eligibility count.
• ME Codes 71 and 72 are no longer used as this population has moved to ME Code 4M.
MO HealthNet Managed Care Eligibles – Eastern Region
Eligibility Criteria Estimated Numbers
MO HealthNet Managed Care and Related Eligibles Groups
Page 10 Revised January 2026
Codes ME Code Description State Fiscal
Year 2023 State Fiscal Year 2024
State Fiscal Year 2025
Parents and 202,959 181,477 148,371 Caretakers, MO HealthNet For Families Children, Newborns 05 MO HealthNet for Families – Adult
06 MO HealthNet for Families – Child MO HealthNet for Kids - Poverty
40 MO HealthNet for Kids - Poverty 62 MO HealthNet for Kids - Health Initiative Fund
4M MO HealthNet for Kids - CHIP Fund Newborns
60 Newborns (Eligibility Only) 6S SMHB Newborns <186% FPL
MO HealthNet Managed Care and Related Eligibles Groups MO HealthNet Managed Care Eligibles – Central Region
Eligibility Criteria Estimated Numbers
Page 11 Revised January 2026
Codes ME Code Description State Fiscal
Year 2023 State Fiscal Year 2024
State Fiscal Year 2025
Pregnant Women 10,143 8,856 9,684 MO HealthNet for Pregnant Women
18 MO HealthNet for Pregnant Women 43 Preg Women-60 days Postpartum - MAF 44 Preg Women-60 days Poverty 45 Preg Women-Poverty 61 Pregnant Woman Poverty 133% -185% FPL
– HIF
95 SMHB* Pregnant Women-income above
196% and up to 300% 96 SMHB* Unborn Child income 0% to 300% 98 SMHB* Post-Partum
*SMHB (Show Me Healthy Babies)
MO HealthNet Managed Care and Related Eligibles Groups MO HealthNet Managed Care Eligibles – Central Region
Eligibility Criteria Estimated Numbers
Page 12 Revised January 2026
Codes ME Code Description State Fiscal
Year 2023 State Fiscal Year 2024
State Fiscal Year 2025
MO HealthNet 16,244 14,738 12,787 Children in Care DSS Division of Family Services and Custody and 07 Foster Care – IV - E Adoption Subsidy 37 Title XIX-FFP/HDN
38 Independent Foster Care Children -Age 18 up to age 26
08 CWS-FC
66 Child Welfare – HIF 0F Foster Care – Title IV-E (State Only - Funded)
0H Foster Care – Non-Title IV-E & IMD (Non- Waiver) (State Only - Funded) Adoption Subsidy
36 Adoption Subsidy-FFP 56 Adoption Subsidy- IV - E Eligible 57 Adoption Subsidy – CWS
5A Adoption/Guardianship Subsidy Title IV-E (State Only – Funded)
5C Adoption/Guardianship Subsidy - Non-Title IV- E & IMD (Non-Waiver) (State Only - Funded) DSS Division of Youth Services
29 Div of Youth Svcs FYS-FC
52 DYS-GR
50 DYS-Poverty
68 DYS - HIF
MO HealthNet Managed Care and Related Eligibles Groups MO HealthNet Managed Care Eligibles – Central Region
Eligibility Criteria Estimated Numbers
Page 13 Revised January 2026
Codes ME Code Description State Fiscal
Year 2023 State Fiscal Year 2024
State Fiscal Year 2025
SCHIP 8,483 12,842 17,873
MO HealthNet For Kids (SCHIP)
73 CHIP 151-185% Age 1-18 74 CHIP 186-225% Age 0-18 75 CHIP 226-300% Age 0-18 97 SMHB* Newborns 9S SMHB* Newborns >=186% FPL%
*SMHB (Show Me Healthy Babies)
MO HealthNet Managed Care Eligibles – Central Region
Eligibility Criteria Estimated Numbers
MO HealthNet Managed Care and Related Eligibles Groups
Page 14 Revised January 2026
Codes ME Code Description State Fiscal
Year 2023 State Fiscal Year 2024
State Fiscal Year 2025
AEG 76,548 88,596 91,646
Adult Expansion Group
E2 Adult Expansion Group < 138% Age 19-64
Source:
• COA 1, 2, 5, & 6: Missouri Medicaid Central Region Eligibility Data.
• COA 4: Missouri Medicaid Central Region Managed Care Data.
Note:
• The estimated numbers above are an average monthly eligibility count.
• ME Codes 71 and 72 are no longer used as this population has moved to ME Code 4M.
MO HealthNet Managed Care Eligibles – Central Region
Eligibility Criteria Estimated Numbers
MO HealthNet Managed Care and Related Eligibles Groups
Page 15 Revised January 2026
Codes ME Code Description State Fiscal
Year 2023 State Fiscal Year 2024
State Fiscal Year 2025
Parents and 146,574 131,253 107,408 Caretakers, MO HealthNet For Families Children, Newborns 05 MO HealthNet for Families – Adult
06 MO HealthNet for Families – Child MO HealthNet for Kids - Poverty
40 MO HealthNet for Kids - Poverty 62 MO HealthNet for Kids - Health Initiative Fund
4M MO HealthNet for Kids - CHIP Fund Newborns
60 Newborns (Eligibility Only) 6S SMHB Newborns <186% FPL
MO HealthNet Managed Care and Related Eligibles Groups MO HealthNet Managed Care Eligibles – Southwestern Region
Eligibility Criteria Estimated Numbers
Page 16 Revised January 2026
Codes ME Code Description State Fiscal
Year 2023 State Fiscal Year 2024
State Fiscal Year 2025
Pregnant Women 8,139 7,211 7,733 MO HealthNet for Pregnant Women
18 MO HealthNet for Pregnant Women 43 Preg Women-60 days Postpartum - MAF 44 Preg Women-60 days Poverty 45 Preg Women-Poverty 61 Pregnant Woman Poverty 133% -185% FPL
– HIF
95 SMHB* Pregnant Women-income above
196% and up to 300% 96 SMHB* Unborn Child income 0% to 300% 98 SMHB* Post-Partum
*SMHB (Show Me Healthy Babies)
MO HealthNet Managed Care and Related Eligibles Groups MO HealthNet Managed Care Eligibles – Southwestern Region
Eligibility Criteria Estimated Numbers
Page 17 Revised January 2026
Codes ME Code Description State Fiscal
Year 2023 State Fiscal Year 2024
State Fiscal Year 2025
MO HealthNet 10,905 10,030 8,627 Children in Care DSS Division of Family Services and Custody and 07 Foster Care – IV - E Adoption Subsidy 37 Title XIX-FFP/HDN
38 Independent Foster Care Children -Age 18 up to age 26
08 CWS-FC
66 Child Welfare – HIF 0F Foster Care – Title IV-E (State Only - Funded)
0H Foster Care – Non-Title IV-E & IMD (Non- Waiver) (State Only - Funded) Adoption Subsidy
36 Adoption Subsidy-FFP 56 Adoption Subsidy- IV - E Eligible 57 Adoption Subsidy – CWS
5A Adoption/Guardianship Subsidy Title IV-E (State Only – Funded)
5C Adoption/Guardianship Subsidy - Non-Title IV- E & IMD (Non-Waiver) (State Only - Funded) DSS Division of Youth Services
29 Div of Youth Svcs FYS-FC
52 DYS-GR
50 DYS-Poverty
68 DYS - HIF
MO HealthNet Managed Care and Related Eligibles Groups MO HealthNet Managed Care Eligibles – Southwestern Region
Eligibility Criteria Estimated Numbers
Page 18 Revised January 2026
Codes ME Code Description State Fiscal
Year 2023 State Fiscal Year 2024
State Fiscal Year 2025
SCHIP 6,224 9,514 13,508
MO HealthNet For Kids (SCHIP)
73 CHIP 151-185% Age 1-18 74 CHIP 186-225% Age 0-18 75 CHIP 226-300% Age 0-18 97 SMHB* Newborns 9S SMHB* Newborns >=186% FPL%
*SMHB (Show Me Healthy Babies)
MO HealthNet Managed Care Eligibles – Southwestern Region
Eligibility Criteria Estimated Numbers
MO HealthNet Managed Care and Related Eligibles Groups
Page 19 Revised January 2026
Codes ME Code Description State Fiscal
Year 2023 State Fiscal Year 2024
State Fiscal Year 2025
AEG 54,527 61,812 63,862
Adult Expansion Group
E2 Adult Expansion Group < 138% Age 19-64
Source:
• COA 1, 2, 5, & 6: Missouri Medicaid Southwest Region Eligibility Data.
• COA 4: Missouri Medicaid Southwest Region Managed Care Data.
Note:
• The estimated numbers above are an average monthly eligibility count.
• ME Codes 71 and 72 are no longer used as this population has moved to ME Code 4M.
MO HealthNet Managed Care Eligibles – Southwestern Region
Eligibility Criteria Estimated Numbers
MO HealthNet Managed Care and Related Eligibles Groups
Page 20 Revised January 2026
| West Region |
| West Region COA 4 |
| East Region |
| East Region COA 4 |
| Central Region |
| Central Region COA 4 |
| SouthWest Region |
| SouthWest Region COA 4 |
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