The Metabolic Formula Program provides financial assistance to Missouri residents who meet the financial and medical eligibility criteria of the program.
Program Services
The Department of Health and Senior Services (DHSS) will provide financial assistance to program participants for the purchase of metabolic formula. Prescriptions for formula must be filled at a DHSS contracted provider. For a list of providers and to apply for services, please contact the Metabolic Formula Program at (573) 751-6266.
Eligibility
The participant must:
- Be a Missouri resident.
- Have a medical diagnosis of one of the inborn errors of metabolism screened for on the Missouri Newborn Blood Spot Screening panel. Examples of these disorders include phenylketonuria (PKU), maple syrup urine disease (MSUD), homocystinuria (HCU), tyrosinemia and propionic acidemia. (For other possible eligible diagnoses which have a metabolic formula need, please go to Missouri Blood Spot Screening Panel.
- Meet financial eligibility guidelines:
- Birth through five years of age: any child is eligible; regardless of financial status.
- Six through 18 years of age: a co-pay for formula is required based on the percent of Federal Poverty Level (FPL) calculated from the adjusted gross income and the number of family members.
- Nineteen years and above: 185% of the FPL with an adjustment of two to the family size.
- Apply for MO HealthNet (Medicaid) benefits or medical assistance and complete the application process to obtain or maintain program eligibility.
MFP is the payer of last resort. All third-party payment sources must be utilized before reimbursement is considered.
Guidelines
The following table provides program financial eligibility guidelines for various age ranges and income levels. It also displays the percent the participant pays, if applicable, of the formula cost per order. (See the column titled: Percent the Participant Pays.)
*Note: To determine financial eligibility, look at the number of family members claimed on the applicant’s federal income tax filing and refer to that number in the Family Size column.
Age range | Financial Eligibility (Percent of Federal Poverty Level) | Family Member Adjustment | Family size | Maximum yearly income | Percent the Participant Pays | Percent DHSS pays |
|---|---|---|---|---|---|---|
0 through 5 | Any income | None | N/A | N/A | Zero | 100% |
| 6 through 18 | Less than 300% | None | 1 | At or below $47,880 | Zero | 100% |
| 2 | $64,920 | |||||
| 3 | $81,960 | |||||
| 4 | $99,000 | |||||
| 5 | $116,040 | |||||
| 6 | $133,080 | |||||
| 7 | $150,120 | |||||
| 8 | $167,160 | |||||
Less than 400% | None | 1 | Less than $63,840 | 25% | 75% | |
| 2 | $86,560 | |||||
| 3 | $109,280 | |||||
| 4 | $132,000 | |||||
| 5 | $154,720 | |||||
| 6 | $177,440 | |||||
| 7 | $200,160 | |||||
| 8 | $222,880 | |||||
Less than 500% | None | 1 | Less than $79,800 | 40% | 60% | |
| 2 | $108,200 | |||||
| 3 | $136,600 | |||||
| 4 | $165,000 | |||||
| 5 | $193,400 | |||||
| 6 | $221,800 | |||||
| 7 | $250,200 | |||||
| 8 | $278,600 | |||||
500% and over | None | 1 | At or above $79,800 | 50% | 50% | |
| 2 | $108,200 | |||||
| 3 | $136,600 | |||||
| 4 | $165,000 | |||||
| 5 | $193,400 | |||||
| 6 | $221,800 | |||||
| 7 | $250,200 | |||||
| 8 | $278,600 | |||||
19 and over | Up to 185% | 2* | 1 | At or below $50,542 | Zero | 100% |
| 2 | $61,050 | |||||
| 3 | $71,558 | |||||
| 4 | $82,066 | |||||
| 5 | $92,574 | |||||
| 6 | $103,082 | |||||
| 7 | $113,590 | |||||
| 8 | $124,098 |
Treatment Centers
Cardinal Glennon Children's Hospital
1465 South Grand Blvd.
St. Louis, MO 63104
(314) 577-5639
St. Louis Children's Hospital
One Children's Place
St. Louis, MO 63110
(314) 454-6093
Children's Mercy Hospital
2401 Gillham Road
Kansas City, MO 64108
(816) 234-3290
MU Health Care
One Hospital Drive
Columbia, MO 65212
(573) 875-9000
Laws
Infants to be tested for metabolic and genetic diseases--reports --exceptions--refusal to test--fee for screening test, department may impose by rule, use of fees--formula provided by department, when.