0810.000.00 MO HealthNet Coverage

0810.010.20 Spend Down Pay-In Option

IM-08 January 24, 2012; IM-106 September 10, 2002

The pay-in option allows participants to meet their spend down obligation by making a monthly payment of their spend down amount to the State, much like paying a monthly health insurance premium. They have two options to pay-in their spend down. They must choose only 1 option. Participants will have coverage for the whole month that they pay for.

  • Option 1: Participants may send a payment (check, money order, or cashier’s check) to the MO HealthNet Division. Participants may mail spend down payments to:
    MO HealthNet Division
    P.O. Box 808001
    Kansas City, MO 64180-8001

    The participant must put their MO HealthNet number (case number) on the check or money order. They should mail their payment along with the invoice stub for the month for which they are paying. If they do not have the correct invoice stub to send, they must write on the check or money order what month they are paying for. They must not send an old invoice to pay for a current month.

  • Option 2: Participants may have their payment taken directly out of their bank account on the 10th of each month by the MO HealthNet Division to pay for their spend down obligation for the following month. To have their payment automatically taken from their bank account the participant must complete the Spend Down Automatic Withdrawal Authorization. They must allow 30 days for the automatic withdrawal to process. The participants cannot use bills to meet their spend down if they chose to have the payment taken from their bank account each month through automatic withdrawal. If the participant has insufficient funds to cover the automatic withdrawal, they must send either a money order or cashier’s check to cover the insufficient payment.
  • If the participant changes banks or changes accounts within their bank, they will need to submit a new automatic withdrawal form marked “change,” and will need to allow 30 days for this change to take place.

Participants who pay-in will have continuous coverage as long as payment is received prior to the first day of the month for which they are paying. When a participant pays in, MHD will create a coverage period on the MSPI screen that begins on the first day of the month for which the participant is paying. If the participant pays for the next month prior to the end of the current month, there will be no end date on the coverage period.  If a payment has been missed, the MSPI screen will show the coverage dates with an end date of the last day of the month for which MHD received payment.

As long as the case remains open, a participant may pay-in retroactively for any month up to twelve months after the invoice for that month was sent. If the payment is received after a month has ended, the MHD will create a coverage period on MSPI beginning the first day of the month and ending the last day of the month.

If a participant does not have MO HealthNet claims paid that equal or exceed the spend down amount that they paid for that month, the difference will be refunded to the participant thirteen months later. It takes thirteen months for MHD to process the refund because providers may bill MO HealthNet for twelve months from the date of service.