Understanding Medicaid: Coverage, Eligibility and Services

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

• You should receive a letter in the mail with open enrollment dates. You may also call the MO HealthNet Managed Care Enrollment Helpline at 800.348.6627 or the MO HealthNet Participant Services Unit at 800.392.2161 or 573.751.6527.

Oklahoma

• Every year from May 1 to June 13.

Arkansas PASSE

• Every year from October 1 to October 31.

Kansas

• If your open enrollment is in January, you’ll get your packet in October. The enrollment period lasts until March. If your open enrollment is later, you’ll get your packet in the following months.

Illinois

• HealthChoice IL will send patients an open enrollment letter about two months prior to their anniversary date. Any change you make will start on your anniversary date. 

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

In addition, if you need assistance in determining eligibility and applying for Medicaid in your state of residence, contact Eligibility Services Call Center at 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 to browse under the "Find a Provider" section. Plan provider directories are also available on each plan’s website to help with this decision.

Medicaid covers a wide range of health care services to help you stay healthy and treat illness. Most preventive care, including your annual checkup with your primary care provider (PCP), is covered at no cost to you.

Your Medicaid benefits typically include:

• Annual wellness visits with your PCP (no copay for most members)
• Sick visits when you're ill
• Preventive care, including physical exams and recommended screenings
• Vaccines (immunizations)
• Women's health and maternity care
• Children's health services, including Healthy Children and Youth (HCY/EPSDT) services
• Behavioral health and substance use treatment
• Emergency care
• Hospital stays and outpatient care
• Prescription medications (covered medications vary by plan)

Many Medicaid plans also offer extra (value-added) benefits beyond standard health services coverage.

These extra benefits vary by health plan and state, so be sure to check your plan's Member Services or benefits information to see what's available to you.

Medicaid generally doesn’t cover services that aren’t medically necessary, such as cosmetic surgery.

Not sure what your plan covers? Visit your plan’s Member Services page using the links below.

Depending on your state, age, income, health status and individual circumstances, you may be eligible for Medicaid. Visit your state's Medicaid website to review eligibility requirements and determine whether you qualify.

• Arkansas: Arkansas Medicaid Programs
• Illinois: Illinois Medicaid Programs
• Kansas: KanCare Medicaid Programs
• Missouri: Missouri Medicaid Programs
• Oklahoma: Oklahoma Medicaid Programs​

Missouri

• You may change managed Medicaid plans for any reason during the first 90 days of enrollment.
• Once the 90-day change period ends, you’re locked into your MO HealthNet Managed Care health plan for one year unless you have “just cause” to ask for a change and it’s approved. Examples of “just cause” include:
  • Your primary care provider is no longer in your MO HealthNet Managed Care health plan (but is with another plan)
  • You need to transfer to another MO HealthNet Managed Care health plan to ensure continuity of care
  • There’s been an act of cultural insensitivity that negatively impacts your 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

• You may change managed Medicaid plans for any reason during the first 90 days of enrollment. Once your lock-in period begins after the 90 days, you’ll remain in your plan until the next open enrollment period.

Arkansas PASSE

• If you would like to change your PASSE, you may do so 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 don’t 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, you’ll have a “good cause” reason that may allow you to change in the middle of the year, such as:
  • You live in a nursing home that no longer accepts your plan
  • You don’t have access to covered services or providers
  • You need a certain medical treatment (specialist or specialty care) that’s not available in your health plan

Illinois

• You may change managed Medicaid plans for any reason during the first 90 days of enrollment. Once your lock-in period begins after the 90 days, you’ll remain in your plan until the next open enrollment period.

It depends on the plan you choose. To make sure your Mercy provider is in-network, search here. Out-of-network providers may cost more or may not be covered. Never delay getting emergency care.

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.