Nursing Homes in Missouri
Americans are living longer, with the 65+ community projected to double to 80 million by 2040. With age comes a greater risk of developing a chronic health condition, such as heart disease and type 2 diabetes. Consequently, seniors are increasingly likely to need nursing home care to help manage their conditions. Within these facilities, patients are cared for by registered nurses, licensed practical nurses and certified nursing assistants. There will likely be on-site therapists and visiting physicians (although some facilities have permanent doctors on staff). Combined, these teams deliver comprehensive medical care around the clock.
Adults aged 65 and older make up 17.6% of Missouri's population, and the state's 514 nursing homes care for about 33,400 residents — accounting for approximately 3% of Missouri's seniors. This guide covers how Medicaid can help eligible applicants pay for the costs of nursing home care, and it discusses alternative payment methods if Medicaid isn't an option. It also lists numerous free and low-cost resources that can help seniors and their families and briefly touches on the rules and regulations governing nursing home care in Missouri.
Popular Cities in Missouri
Cost of Missouri Nursing Homes
The average cost of nursing homes in Missouri is $153 per day. This is higher than the national average which is $228 per day.
Can You Use Medicaid to Pay for Nursing Home Care in Missouri?
MO HealthNet, Missouri's Medicaid program, can pay all of a senior's medical and nonmedical nursing home costs if they satisfy the qualifying criteria and require more than 30 consecutive days of care. Approximately 1.43 million of Missouri's citizens are enrolled in Medicaid and CHIP as of December 2022 (although this accounts for other residents in need, not just seniors). As Medicaid is an entitlement program, those who are approved can receive nursing home care almost immediately. As standard, the senior will reside in a private or semiprivate room, be served three nutritionally balanced meals every day and be encouraged to participate in physically and mentally stimulating activities suitable for their current state of health.
Not all seniors want to enter a nursing home, so MO HealthNet makes provision for those whose conditions can be treated safely at home or in the community. The Aged and Disabled Waiver covers medical costs for adults aged 63+, such as visits from licensed professionals, and some nonmedical costs, including home-delivered meals and home care services. It's not an entitlement program, so approved applicants may join a waiting list. The Program of All-Inclusive Care for the Elderly (PACE) may be available to seniors who qualify for Medicaid and Medicare if they live in an area with a PACE provider. The approved provider handles all aspects of the resident's care, including primary care, meals, dentistry and prescription drugs.
Eligibility for Medicaid in Missouri
To be eligible for Missouri's regular Medicaid, the applicant's entire household income can't exceed 85% of the federal poverty limit. All income counts if Medicaid is to pay nursing home costs, including pension payments and Social Security. The senior can retain a $50 per month personal needs allowance and enough to pay Medicare and other insurance premiums. The senior's assets can't exceed $5,301.85, although their home, one vehicle or household goods shouldn't be counted. As per the Prevention of Spousal Impoverishment Act, the remaining spouse can retain enough to cover their living costs, known as the Division of Assets. If both persons in the household apply, the income and assets limits are $16,762 and $10,603.70, respectively.
| Income Limits* | Asset Limits | |
|---|---|---|
| Single Person | $12,393 | $5,301.85 |
| Two-Person Household | $16,762 | $10,603.70 |
*Per year
In addition to satisfying the income and assets limits, the senior must also fulfill other qualifying criteria. These include:
- Being a U.S. citizen or legal noncitizen
- Residing in Missouri
- Having or being able to apply for a Social Security number
- Not being a resident of a private, public or endowed facility (except for a public medical institution)
- Requiring nursing home levels of medical care
Applying for Medicaid in Missouri
MO HealthNet provides several ways seniors can apply for Medicaid, each designed for people with different communication preferences. They are:
- Online: The speediest option for seniors comfortable with computers is to visit My DSS, where they can apply for other state benefits as well as Medicaid.
- Email: Those able to download the application form can scan a completed copy and email it to MO HealthNet.
- Phone: Seniors who prefer to use the phone can call MO HealthNet at (855) 373-9994.
- In-person: Those who value face-to-face communication can call (855) 373-9994 or go online to arrange an appointment at their nearest DSS office.
- Mail: Seniors able to download the application form can post a completed copy to:
Family Support Division
615 East 13th Street
Kansas City, MO 64106
The waiting time for approval is affected by the senior's communication method, although 10 working days is common. The senior will receive a letter confirming their acceptance for Medicaid or rejection. An approved senior is sent an MO HealthNet ID card and confirmation of their level of coverage.
Information You Will Need
To minimize avoidable delays in their applications, seniors and their families should collate evidence of their qualifying status. These typically include:
- Social Security numbers
- Proof of the previous 30 days of income, such as banks statements, for all household members
- Proof of Missouri residency, such as a driving license
- Immigration documents if not a U.S. citizen
- All insurance policy numbers, including Medicare, for every household member
Additional Medicaid Support & Resources in Missouri
Seniors and families in Missouri considering Medicaid have numerous free resources at their disposal. The following table includes nonprofits that provide detailed information, useful tools for those who like to do their own research and direct help for Missourians who may not yet meet Medicaid's standard criteria.
| Contact | Service | |
|---|---|---|
| Missouri Care Options | (866) 835-3505 | Families looking for help choosing the best long-term care options for their loved ones can contact Missouri Care Options. It can help them determine if there are suitable alternatives to nursing home care that don't compromise on standards or access to health care. The program also helps with Medicaid applications. |
| American Council on Aging | Online Only | This website contains a wealth of easily accessible information about Medicaid in general and how it applies in Missouri. The content is created and maintained by experts on the subjects, and the site includes useful tools for families, such as a Medicaid eligibility test and spend down calculator. |
| Missouri Foundation for Health | (800) 655-5560 | This independent nonprofit can help Missourians who sometimes miss out on Medicaid due to their age or location. It helps them gain access to the state benefit to pay for much-needed medical care. Services include direct information and referrals to other nonprofits that can help. |
Can You Use Medicare to Pay for Nursing Home Care in Missouri?
Medicare provides limited coverage for short-term stays in a skilled nursing facility following a hospital stay, but seniors must meet a number of specific requirements. This benefit is available to beneficiaries who have been hospitalized for at least three days, excluding the date of discharge, so it's most valuable for those who are recovering from an injury, illness, or surgery.
Once seniors meet the hospitalization requirement, Medicare will pay for up to 100 days of skilled nursing per benefit period. The first 20 days are covered in full. Starting on day 21, beneficiaries must pay a daily coinsurance rate. After day 100, seniors are responsible for the entire cost.
What Does Medicare Cover?
Medicare covers a number of specific services, including:
- Meals
- A semiprivate room
- Medications
- Skilled nursing
- Physical therapy
- Occupational therapy
- Speech therapy
- Audiologist care
- Medical supplies
- Medical social services
- Nutritional counseling
- Ambulance transportation
What Isn't Covered by Medicare?
Medicare does not cover long-term custodial care that addresses seniors' day-to-day needs. This includes help with daily activities, such as bathing, dressing and using medical equipment.
For more information about Medicare and when it covers Nursing Home Care, read our Guide to Nursing Homes.
Medicare Support & Resources in Missouri
Several useful resources are available to Missouri seniors and families who want to know more about Medicare and how it can help them cover care costs. This table includes four options that provide services free of charge.
| Contact | Service | |
|---|---|---|
| Medicare Cost Savings Programs | (855) 373-4636 | Seniors struggling to pay their Medicare premiums may qualify for financial assistance. The Qualified Medicare Beneficiary (QMB) program pays Medicare Part B premiums, coinsurance and deductibles for Medicare Part A beneficiaries. The Low-Income Medicare Beneficiary program helps those with incomes disqualifying them from QMB by paying Medicare Part B premiums. |
| Senior Medicare Patrol program | (888) 515-6565 | Volunteers from the Senior Medicare Patrol program help prevent Medicare and Medicaid fraud. Their roles include educating seniors on how to spot signs of deception by fraudsters, such as bills for Medicare services they never had, and how to prevent criminals from accessing their personal details. |
| Medicare.gov | (800) 633-4227 | The federal government's site for Medicare hosts the latest information about the program. Those who like to self-research will find an abundance of general information and content specific to Missouri. Seniors can manage elements of their Medicare plans directly from the site and get answers to queries from a chatbot. |
| CLAIM | (800) 390-3330 | CLAIM is Missouri's State Health Insurance Assistance Program. Its counselors provide impartial information, advice and support on all aspects of Medicare and supplementary programs, such as Medigap. They also advocate for seniors whose Medicare applications are denied. Services are free of charge, and counselors will not try to sell insurance. |
Other Financial Assistance Options for Nursing Home Care in Missouri
While Medicaid and Medicare are two of the most common programs used to pay for Nursing Home Care, there are other financial assistance options available, depending on your unique situation.
| How to Apply | How It Works | |
|---|---|---|
| Aid and Attendance | Learn more and apply online at va.gov. | Veterans who receive a VA pension may also be eligible for the Aid and Attendance benefit, a monthly cash allowance that veterans receive in addition to their standard pension amount. The benefit is intended for veterans in need of long-term care services and may be used towards paying for skilled nursing care. |
| Reverse Mortgages | Learn more about your options and how to apply at ftc.gov. | If you own a home, you may be able to use a reverse mortgage to help pay for nursing care. Reverse mortgages are loans that one can take out against the value of their home, essentially converting some of the home's equity into cash. This type of funding can be especially useful for married couples when only one partner needs nursing care, as the other residents of the home may continue living there. Reverse mortgage loans do need to be repaid with interest, typically within 12 months of receiving the loan. |
| Long-Term Care (LTC) Insurance | Learn more about Long-Term Care Insurance and how to apply for a policy at acl.gov. | Seniors who already have long-term care insurance may be covered for skilled nursing care. Most policies cover at least a portion of the cost of nursing home care, but it depends on the specific policy terms. Note that older adults who are already in need of skilled nursing care will not be eligible to sign up for a LTC insurance policy. |
Nursing Home Laws and Regulations in Missouri
| Licensing Requirements | Missouri nursing homes must be licensed by the Department of Health and Senior Services. To be licensed, the facility must satisfy an array of criteria, including financial stability, compliance with building codes, appropriate staff qualifications and adherence to fire safety and patient safety regulations. |
| Staffing Requirements | There must be a director with a Missouri nursing home administrator license and a physician to coordinate medical care. The director of nursing must be a registered nurse, and nursing staff must be on duty and on every floor of the facility 24/7. |
| Staff Training Requirements | Staff training must be provided by trainers licensed to deliver the specific subjects. All nursing assistants must complete a training program approved by the state of Missouri, and there must be regular ongoing training for all staff, including housekeeping and food preparation employees. |
| Admission Restrictions | Nursing homes can only accept seniors with conditions they have the skills and equipment to treat. They must seriously consider the risks of accepting patients with a history of violent or disruptive behavior. |
| Care Planning Requirements | The resident's personal care plan must be completed within 14 days of their admission and should be reviewed and updated accordingly every 90 days thereafter (or earlier if their condition changes). |
| Dietary and Nutritional Services Requirements | A dietician or an equally qualified professional must assess each resident's dietary needs. Meals must account for specific dietary needs and should include the nutrients seniors require in appropriate amounts. A food service supervisor must oversee the entire process. |
| Specialized Rehabilitative Services | Rehabilitative services must be appropriate to residents' needs. These may include physical, occupational and speech therapies. If it can't directly deliver the service, the facility must arrange for help from an external provider. |
| Medication and Pharmaceutical Services | The facility's policies and procedures must be developed with a licensed pharmacist, and only a licensed professional can write an order for residents' medications. Only licensed staff who have completed a state-approved course can administer medications. |
| Activities Requirements | Activity programs must satisfy residents' medical and recreational needs and be available on a daily basis. Every resident must have a written program designed to enhance their physical and cognitive abilities. They must also have access to programs that satisfy their spiritual needs. |
| Infection Control Requirements | There must be policies outlining the continuous monitoring of surfaces to minimize the spread of potentially infectious bacteria. Staff must receive appropriate training and follow guidelines on hand hygiene and PPE. Outbreaks must be reported to the Department of Health and Senior Services. |
| Medicaid Coverage | Missouri nursing homes that want to accept Medicaid-eligible residents must be certified by the Department of Health and Senior Services. Medicaid will cover 100% of the remaining costs for qualifying seniors after they have contributed what they can from their countable incomes. |
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