MedicaidCoverageMedium impact
Nursing Home Room and Board for Managed Care Participants
Missouri Medicaid (MO HealthNet)·MO · Geriatrics, Family Medicine, Internal Medicine·Provider Notice
Effective date
May 18, 2026
We identified it
Jun 20, 2026
Summary
Participants enrolled in Managed Care health plans who need nursing home care will remain in their Managed Care plan for up to 60 days or until doctors determine they need nursing home level of care, whichever comes first. After this period, nursing home room and board costs transfer to Fee-For-Service coverage.
Action Required
Immediately: Billing team must track Managed Care participants entering nursing homes and monitor the 60-day transition period from DA-124 form completion. Coordinate with case management to identify when participants qualify for nursing home level of care. Update billing workflows to switch from Managed Care to Fee-For-Service billing for nursing home room and board after the transition period.