Losing MO HealthNet in Missouri is a stressful moment, and the clock starts on the day your coverage ends. Missouri voters approved Medicaid expansion through Amendment 2 in August 2020, and adults ages 19 to 64 with household income at or below 138% of the Federal Poverty Level have qualified since coverage began in October 2021. Since then, coverage has ended for several reasons: a renewal packet that went unanswered, a data match that showed higher income, a move that left a notice undelivered, or a real income increase. Under federal rules, losing Medicaid or CHIP is a qualifying life event that opens a Marketplace Special Enrollment Period (SEP) of 90 days after the coverage end date, according to healthcare.gov. The temporary unwinding-era SEP has expired, so the standard Medicaid-loss SEP is the rule that applies in 2026. This guide covers the seven steps to protect your coverage, the Missouri hearing process, and what each option costs in 2026.
Missouri residents enroll in Marketplace plans through HealthCare.gov, not a state-run exchange, as of 2026. The Missouri Department of Social Services, Family Support Division (FSD) runs MO HealthNet eligibility, notices, and hearings, so two agencies handle your case: FSD for Medicaid and the federal Marketplace for private plans. If your account shows you were denied or terminated, HealthCare.gov can also receive your information from the state and screen you for premium tax credits. Missouri also faces a change on the horizon. Missouri's Department of Social Services has announced that expansion-adult work reporting requirements and six-month eligibility reviews under the federal law known as H.R. 1 begin January 1, 2027, and verifying that date at dss.mo.gov matters if you plan to reapply. For now, the practical advice is simple: confirm the end date, file the hearing request if you think the decision is wrong, and select a Marketplace plan before the 90 days run out. Check the Medicaid income limits and ACA income limits pages to see where your 2026 income lands.
7 Steps to Get Coverage
Common Mistakes That Cost People Thousands
Missourians who lose MO HealthNet in 2026 most often run into these mistakes:
- Waiting to request a hearing past the 10-day mark. A hearing request within 10 days of the notice date keeps benefits going, while a later request within 90 days preserves your appeal but may leave a gap.
- Treating the hearing and the Marketplace plan as either/or. The 90-day SEP and the 90-day hearing window run at the same time, so file the hearing request and select a HealthCare.gov plan together.
- Reporting 2025 income instead of projected 2026 income. Premium tax credits use projected 2026 Modified Adjusted Gross Income (MAGI), and a wrong estimate can create a repayment bill when you file with your 1095-A.
- Assuming an unpaid first premium still leaves you covered. A Marketplace plan stays inactive until the insurer receives payment, so pay the first month's premium the day you select the plan.
- Buying a short-term plan to save money. Short-term plans skip ACA protections for pre-existing conditions and do not count as minimum essential coverage, so use healthcare.gov for ACA-compliant coverage.
Why MO HealthNet Coverage Ends in Missouri in 2026 and Which Closures Are Worth Contesting
Missouri MO HealthNet closures in 2026 generally fall into three groups, and each group calls for a different response. Procedural closures happen when the Family Support Division does not receive a renewal form or requested verification by the due date, even though the member may still qualify. These are the strongest candidates for a quick fix: returning the paperwork inside the federal reconsideration period under 42 CFR 435.916 can restore coverage without a new application. Income-based closures happen when a data match shows household income above 138% FPL ($22,025 for 1 person in 2026), and the right response is to check the figures, correct any error, and otherwise move to a Marketplace plan. Eligibility-category closures happen when a child ages out, a pregnancy coverage period ends, or a household member moves out of state. Whichever group applies, compare the reason printed on your Action Notice with your actual 2026 situation before you decide. A closure labeled as failure to respond is a paperwork problem, while a closure labeled as excess income is an eligibility question, and the two call for different documents. Ask the Family Support Division to read the case notes to you if the notice is unclear, and write down the name of the person and the date of the call.
Federal rules treat the end of Medicaid or CHIP coverage as a qualifying life event for a Marketplace Special Enrollment Period of 90 days after the end date, according to healthcare.gov, with a second option to select a plan up to 60 days before the loss when you know the date in advance. The temporary SEP created for the 2023 to 2024 Medicaid unwinding expired in 2024, so no extended unwinding window applies in 2026. The 90-day Marketplace SEP and the 90-day hearing window are separate rights, and using one does not forfeit the other. Hearing outcomes vary by case, so treat reinstatement as a possibility and the Marketplace plan as the safety net. Medicaid.gov and the CMS consumer guide on losing Medicaid or CHIP both describe the same Marketplace path, and KFF tracks how the federal rules change. Document every date: the notice date, the end date, the hearing request date, and the plan selection date. A clean paper trail helps if HealthCare.gov asks you to confirm the qualifying life event or if you need to show the hearing was filed on time.
Medicaid Income Limits and Premium Tax Credits for Missourians in 2026
Missouri's 2026 eligibility ladder starts with free MO HealthNet for adults ages 19 to 64 at or below 138% FPL, which is $22,025 for 1 person and $45,540 for a family of 4 under the 2026 HHS poverty guidelines. Between 138% and 400% FPL, premium tax credits on HealthCare.gov reduce the monthly cost of the benchmark Silver plan to a share of income. The IRS 2026 applicable percentages start near 3% of income at the bottom of that range and rise to about 10% at 300% FPL and above, so a single adult at 150% FPL ($23,940) pays roughly $84 per month for the benchmark plan, and a single adult at 200% FPL ($31,920) pays roughly $176 per month. These are estimates calculated from the published percentages, and your actual cost depends on your ZIP code and age. The enhanced credits expired January 1, 2026, so the 400% FPL cliff ($63,840 for 1 person) applies again.
Cost-sharing reductions add value for lower incomes. Silver plans purchased on HealthCare.gov carry lower deductibles and out-of-pocket maximums for incomes up to 250% FPL ($39,900 for 1 person in 2026), and only Silver plans include them. The 2026 Marketplace out-of-pocket maximum is $10,600 for an individual and $21,200 for a family before those reductions apply. Children in the household are a separate calculation: MO HealthNet for Kids covers children up to 300% FPL, so a family can have parents on a Marketplace plan and children on Missouri's CHIP. Check the federal poverty level page and the screener to see which programs your household qualifies for before you choose. A household that includes both adults above 138% FPL and children eligible for CHIP should apply for everyone at once through HealthCare.gov or mydss.mo.gov, so the agencies can route each person to the right program. Use the 2026 table above to place your household size against the 138%, 250%, and 400% FPL lines.
What Changes for Missouri Expansion Adults on January 1, 2027
Missouri's Department of Social Services has said that expansion-adult work reporting requirements and six-month eligibility reviews under the federal H.R. 1 law start January 1, 2027, and that notices to affected members were scheduled to go out in August and September 2026. Reported details include 80 hours per month of work or other qualifying activity for adults ages 19 to 64 in the expansion group, with children, seniors, and people in MO HealthNet for the Aged, Blind, or Disabled outside the rule. Details such as the exemption list can change, and some advocacy materials cite different dates, so verify the start date and exemptions at dss.mo.gov before you rely on them. If you lose MO HealthNet now and reapply later, expect the new reporting and review schedule to apply to you once it begins. Keep a Marketplace plan in place as a bridge, and keep the notices FSD mails to you.
Frequently Asked Questions
How long do I have to enroll in a HealthCare.gov plan after losing MO HealthNet?
You have 90 days after the date your Missouri Medicaid coverage ends to select a HealthCare.gov plan under the Medicaid-loss Special Enrollment Period, per healthcare.gov. For example, if coverage ends October 31, 2026, your window runs November 1, 2026 through January 29, 2027. You can also select a plan up to 60 days before the end date if you already know it. After the window closes you must wait for Open Enrollment, which runs November 1, 2026 through January 15, 2027 for 2027 coverage. MO HealthNet itself is year-round, so you can reapply at any time.
Can I request a hearing and still enroll in a Marketplace plan?
Yes, and you should do both in the same week. A hearing request to the DSS Administrative Hearings Unit does not block a HealthCare.gov application during your 90-day SEP. Request the hearing within 10 days of the Action Notice date to keep MO HealthNet benefits while it is pending, or within 90 days of the notice date to preserve the appeal. If the decision is upheld, you may owe the cost of services received while the hearing was pending. If you win, you can cancel the Marketplace plan, so the plan works as a safety net.
How do I document my Medicaid loss for the Marketplace SEP?
Upload the Action Notice from the Missouri Family Support Division that shows your coverage end date and the closure reason. HealthCare.gov generally gives you 30 days after plan selection to send proof, and the document can be a photo or scan uploaded to your account. Have your Social Security numbers, Missouri address proof, and projected 2026 income records ready as well. If you never received the notice, log in to mydss.mo.gov or call the FSD Information Center to request a copy, and tell the Marketplace Call Center at 1-800-318-2596 what happened.
What happens if I miss the 90-day Special Enrollment Period?
You cannot buy a Marketplace plan until Open Enrollment unless another qualifying life event opens a new SEP, such as marriage, a birth, or a move. For 2027 coverage, Open Enrollment runs November 1, 2026 through January 15, 2027 on HealthCare.gov, and plans chosen by December 15 generally start January 1. Until then you could be uninsured. If your income is at or below 138% FPL ($22,025 for 1 person in 2026), you can still apply for MO HealthNet year-round at mydss.mo.gov. Call the Marketplace Call Center if you missed a timely notice, because case-by-case exceptions exist.
Can I get retroactive coverage after losing MO HealthNet?
Marketplace coverage after a Medicaid-loss SEP generally starts the first day of the month after you select a plan, so it is not retroactive to the loss date. If you select a plan before your MO HealthNet ends, coverage can start the first day after Medicaid stops, which avoids a gap. A successful hearing can restore MO HealthNet back to the closure date, so the hearing outcome is the only route to coverage that reaches back. Ask the Family Support Division how retroactive eligibility applies to a new application, because Missouri rules on this have changed over time.
What is the difference between COBRA and Marketplace coverage after losing Medicaid?
COBRA applies only if you also lost an employer group plan, and it costs 102% of the full premium, often $400 to $2,000 per month in 2026. Marketplace plans with premium tax credits usually cost far less for incomes between 138% and 400% FPL, and Silver plans add cost-sharing reductions up to 250% FPL. You have 60 days to elect COBRA after the qualifying event. COBRA makes sense mainly when a specialist is outside Marketplace networks or you already met a large 2026 deductible. Losing Medicaid alone does not create a COBRA right.
What Missouri-specific rules apply to losing MO HealthNet in 2026?
Missouri uses healthcare.gov for Marketplace plans as of 2026, the Family Support Division handles MO HealthNet notices, and the DSS Administrative Hearings Unit handles hearings. Request a hearing within 10 days to keep benefits and within 90 days at the latest. MO HealthNet for Kids covers children up to 300% FPL. Missouri's DSS has announced work reporting and six-month reviews for expansion adults starting January 1, 2027 under H.R. 1, so verify those details at dss.mo.gov. Missouri expanded Medicaid through Amendment 2 in 2020.
Do I qualify for Medicaid again, and what about my children's coverage?
Adults ages 19 to 64 qualify for MO HealthNet at or below 138% FPL, which is $22,025 for 1 person and $45,540 for a family of 4 in 2026. Reapply at mydss.mo.gov if your income has dropped. Children are covered separately: MO HealthNet for Kids, Missouri's CHIP, covers uninsured children up to 300% FPL, with premiums above 150% FPL, and enrollment is year-round. A parent's coverage ending does not automatically end a child's coverage, so check each child's status and apply for any child who lost coverage.
