PURPOSE: This rule establishes the Uninsured Women’s Health Program. This program will provide payment for women’s health services for uninsured women who do not qualify for other medical assistance benefits, and would lose their MO HealthNet eligibility sixty (60) days after the birth of their child or sixty (60) days after a miscarriage, and for women ages eighteen (18) to fifty-five (55) who have a net family income of at or below one hundred eighty-five percent (185%) of the Federal Poverty Level (FPL) and have assets totaling no more than two hundred fifty thousand dollars ($250,000), in order to reduce the possibility of a family’s future dependence on welfare as authorized pursuant to section 208.040, RSMo. The program is authorized pursuant to award of the Missouri’s Women’s Health Services Program approved by the Centers for Medicare and Medicaid Services.

1. (1) Uninsured women who do not qualify for other medical assistance benefits, and would lose their MO HealthNet eligibility sixty (60) days after the birth of their child or sixty (60) days after a miscarriage, and women ages eighteen (18) to fifty-five (55) who have a net family income of at or below one hundred eighty-five percent (185%) of the Federal Poverty Level (FPL) and have assets totaling no more than two hundred fifty thousand dollars ($250,000), shall be eligible to receive medical services to the extent and in the manner provided in this regulation. Uninsured women who do not qualify for other medical assistance benefits, and would lose their MO HealthNet eligibility sixty (60) days after the birth of their child or sixty (60) days after a miscarriage regardless of income, and women ages eighteen (18) to fifty-five (55) who have a net family income of at or below one hundred eighty-five percent (185%) of the Federal Poverty Level (FPL) and have assets totaling no more than two hundred fifty thousand dollars ($250,000), will continue to be eligible for women’s health services only. Women’s health services are defined as: pelvic exams and pap tests, sexually transmitted disease testing and treatment (the treatments of medical complications occurring from the sexually transmitted disease are not covered for this program), family planning counseling/education on various methods of birth control, United States Department of Health and Human Services approved methods of contraception including sterilization and x-ray services related to the sterilization, and drugs (excluding antiretrovirals), supplies, or devices related to the women’s health services described in this rule when they are prescribed by a physician or advanced practice nurse, subject to the National Drug Rebate Program requirements.
2. (2) Uninsured women who do not qualify for other benefits, and would lose their MO HealthNet eligibility sixty (60) days after the birth of their child or sixty (60) days after a miscarriage, and women ages eighteen (18) to fifty-five (55) who have a net family income of at or below one hundred eightyfive percent (185%) of the Federal Poverty Level (FPL) and have assets totaling no more than two hundred fifty thousand dollars ($250,000), are not required to pay a co-payment for women’s health services.
3. (3) The Department of Social Services, MO HealthNet Division shall provide for granting an opportunity for a fair hearing to any applicant or participant whose claim for benefits under the Section 1115, Missouri’s Women’s Health Services Program is denied by the MO HealthNet Division. There are established positions of state hearing officers within the Department of Social Services, Division of Legal Services in order to comply with all pertinent federal and state law and regulations. The state hearing officers shall have authority to conduct state level hearings of an appeal nature and shall serve as direct representative of the director of the MO HealthNet Division.

AUTHORITY: sections 208.040 and 208.201, RSMo Supp. 2008 and section 660.017, RSMo 2000.* Emergency rule filed Sept. 13, 1999, effective Sept. 23, 1999, terminated Oct. 15, 1999. Original rule filed Aug. 16, 1999, effective March 30, 2000. Amended: Filed March 29, 2001, effective Oct. 30, 2001. Emergency amendment filed June 7, 2002, effective July 1, 2002, expired Dec. 27, 2002. Amended: Filed June 11, 2002, effective Nov. 30, 2002. Emergency amendment filed June 7, 2005, effective July 1, 2005, expired Dec. 27, 2005. Amended: Filed June 15, 2005, effective Dec. 30, 2005. Amended: Filed May 14, 2009, effective Nov. 30, 2009. *Original authority: 208.040, RSMo 1939, amended 1941, 1949, 1951, 1953, 1955, 1957, 1973, 1977, 1982, 1983, 1984, 1987, 1994, 1999, 2001; 208.201, RSMo 1987, amended 2007; and 660.017, RSMo 1993, amended 1995.