From 2004 to 2024, the Health Resources and Services Administration (HRSA) funded the National Coordinating Center for the Regional Genetics Networks (NCC). NCC developed and maintained the Genetics Policy Hub.
With the conclusion of NCC funding, the Genetics Policy Hub (GPH) will no longer be updated or maintained. Information on GPH should be used for historical reference only.
Missouri
This data is meant to be used for educational purposes to inform providers, patients, insurers, and state Medicaid agencies what genetic services may or may not be written into each state’s Medicaid policy. The database is not meant to indicate or imply whether a certain program will cover a specific service, since many decisions are made on a case by case basis. If you have specific questions about whether a service is covered, you should reach out to your plan administrator. Please see this disclaimer below for more information.
Medicaid Coverage Information Published
State Contact Information
Todd Richardson
Director, MO HealthNet Division
Missouri Department of Social Services
615 Howerton Court, PO Box 6500
Jefferson City, MO 65102
Phone: (573) 751-6922
https://medicaiddirectors.org/wp-content/uploads/2023/06/Public_DirectorsList_June2023-1.pdf
General Genetic Testing Criteria
Genetic Testing Not Covered
State Specific Definition
Genetic Services for Children
Genetic Counseling Requirement
No requirement.
Metabolic Formula Coverage Legislation
19 CSR 40-7.050
Metabolic Formula Coverage & Criteria
The Department of Health and Senior Services (DHSS) provides low-protein formula, a special dietary product, to individuals diagnosed as having phenylketonuria (PKU), maple syrup urine disease (MSUD) and other metabolic conditions as approved by the Newborn Screening Standing Committee, a subcommittee of the Missouri Genetic Advisory Committee which makes recommendations to the department on newborn screening issues. This rule establishes the criteria by which the Metabolic Formula Program accepts clients for service.
Conditions of eligibility for the Metabolic Formula Program (MFP) include:
- An applicant must be diagnosed as having phenylketonuria (PKU), maple syrup urine disease (MSUD) or other metabolic conditions as approved by the Newborn Screening Standing Committee and recommended to the department. The diagnosis must be made by a physician who practices at a metabolic treatment center;
- An applicant must be a resident of Missouri and cannot reside in a state facility. Proof of residency will consist of submitting a copy of the previous month’s utility bill with the applicant’s home address clearly printed;
- The physician treating the applicant must submit the following information to the department:
- A letter requesting the applicant be placed on the MFP;
- The name and address of the applicant; and
- A prescription, signed by the treating physician, stating the name of the low-protein formula, a special dietary product the individual will be using
Prior Authorization Requirements
Prior Authorization Forms
Fee Schedule
BRCA Testing Coverage
Coverage is available, but criteria is unknown.
Requirements for BRCA
Cystic Fibrosis Screening
Hereditary Cancer Testing Coverage
Coverage is available, but criteria is unknown.
Lynch Syndrome Testing Coverage
Coverage is available, but criteria is unknown.
Microarray Testing
Newborn Screening
Panel Testing
Coverage is available for a variety of genetic conditions. Criteria is unknown.
Pharmacogenetic Testing
Coverage is available, but criteria is unknown.
Prenatal Testing Offered
Whole Exome Sequencing
Other Tests Covered
Genome rapid sequence analysis is listed as a covered benefit.
For a full list of genetic testing covered, see the fee schedule for independent labs.
Other Information
Resources
Newborn Screening Reimbursement
On this Page
Disclaimer: The information contained in the database has been obtained from sources believed to be reliable but NCC has not attempted to validate or confirm the information. The database may be updated periodically. However, the accuracy and completeness of the information contained in the database cannot be, and is not, guaranteed. NCC makes no warranty of the accuracy, completeness or timeliness of this information, and shall not be liable for any decision made in reliance on this information. It is the user’s responsibility to verify this information by contacting the state Medicaid agency directly.
The database contains links to third-party websites. These links are provided solely as a convenience to users and not as a guarantee, warrantee, or recommendation by NCC of the content on such third-party websites or as an indication of any affiliation, sponsorship or endorsement of such third party websites. NCC is not responsible for the content of linked third-party sites and does not make any representations regarding the privacy practices of, or the content or accuracy of materials on, such third-party websites. If you decide to access linked third-party websites, you do so at your own risk. Your use of third-party websites is subject to the terms of use for such sites.