Missouri Sample Letter for List of Medical Expenses

State:
Multi-State
Control #:
US-0817LTR
Format:
Word; 
Rich Text
Instant download

Description

This form is a sample letter in Word format covering the subject matter of the title of the form.

How to fill out Sample Letter For List Of Medical Expenses?

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FAQ

Who is eligible for this program? Household Size*Maximum Income Level (Per Year)5$105,4206$120,8407$136,2608$151,6804 more rows

Medicaid and the Children's Health Insurance Program (CHIP) provide no-cost or low-cost health coverage for eligible children in Missouri. These programs provide health coverage for children so that they can get routine check-ups, immunizations and dental care to keep them healthy.

What is spend down? Spend down is a MO HealthNet program in which you have an amount that you must pay or reach each month before you can have MO HealthNet coverage. It is similar to an insurance premium.

In 2023, that amounts to $20,120 for a single individual, and $34,3065 for a household of three (children were already eligible for Medicaid at higher income levels).

Children 1 ? 18 are eligible if their household income is up to 155% of poverty. For a household of three in 2023, that amounts to just over $38,500 in annual income. Children above the Medicaid income thresholds are eligible for CHIP if their household incomes are up to 305% of poverty.

Call the provider and ask them to bill MO HealthNet. If the provider still bills you, send the bill or a copy of the bill to the Participant Services Unit, P.O. Box 3535, Jefferson City, MO 65102. Include a note with the patient name and MO HealthNet number.

Parents of Dependent Children: Eligibility levels for parents are presented as a percentage of the 2023 FPL for a family of three, which is $24,860. Other Adults: Eligibility limits for other adults are presented as a percentage of the 2023 FPL for an individual, which is $14,580.

States' upper limits for children's CHIP eligibility range from 170 percent of the federal poverty level (FPL) in North Dakota ($44,540 for a family of four in 2020) to 400 percent FPL in New York ($104,800 for a family of four in 2020).

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Missouri Sample Letter for List of Medical Expenses