1840.010.15.20 Special Healthcare Needs – DSS Manuals

Effective July 1, 2004, RSMo 208.647 eliminated the 30-day waiting period in the CHIP75 Premium Group for children with special healthcare needs that do not have access to affordable employer-sponsored health insurance.

Special healthcare needs are defined as a medical condition which left untreated would result in the death of or serious physical injury to a child. Self attestation may be accepted for special healthcare needs.

Evaluate the special healthcare needs exception when:

the child(ren) has no access to affordable private or employer-sponsored healthcare coverage; and

the parent/caretaker has indicated there is a child with special healthcare needs.

Affordable employer-sponsored healthcare is defined in 1840.010.15 Access to Affordable Health Insurance and 1840.010.15.10 Employer-Sponsored Insurance . Children in any of the premium groups (income above 150% FPL) are ineligible if they have access to affordable health insurance, private or employer-sponsored. Refer to 1840.010.15 Access to Affordable Health Insurance .