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Missouri Application for the State Children’s Health Insurance Program Effective Date: 09/01/2007 Approval Date: 09/28/2007

Prior Approval Date: - 6C -  Taking a longer-term view, Missouri has made great strides in reducing the number of uninsured children since the mid-1990’s. The average rate during the seven years prior to full implementation of the 1115 Waiver (1992-1998) is nearly twice as high as the average rate during the seven year period since implementation of the 1115 Waiver (1999-2005): the average rates for these two periods are 11.5 percent and 6.2 percent, respectively. The lower average rate since 1999 is at least partly attributable to the 1115 Waiver, which has provided insurance coverage to children who were either previously uninsured or had lost other coverage and would be uninsured in the absence of the 1115 Waiver. For reference, additional information about the Waiver during this period is available in the “Evaluation of the Missouri Section 1115 Waiver, 2004-05,” which is available http://dss.mo.gov/dms/mc/pdf/eval_1115_04-05.pdf. Specifically, see Research Question #1. As a proxy for the rate of uninsured children in Missouri by by race, we analyzed inpatient discharges in Missouri among children under age 15. This indicator is useful because Missouri hospitals routinely collect and report these data for all patients. Additionally, because inpatient utilization is rarely elective, these data are indicative of the underlying prevalence of payers in Missouri. Accordingly, we used data reported in the Missouri Information for Community Assessment (MICA) to generate:  Rates of such discharges by payer by year (see Table 1);  Rates of such discharges among self-pay patients by race by year (see Table 2); and  Two-year rates of such discharges among self-pay patients by race by sex (see Table 3). Please note that “Self-Pay, Etc.” in Table 1 includes the following responses: self-pay, unknown, and other. Table 2 includes data for only those indicating “self-pay” as their payer. Based on our analyses, it seems that the rate of inpatient discharges among self-pay children has increased consistently for all races and sexes since 2002. This change largely reversed the earlier declines. Additionally, it appears that the self-pay population remains sizeable and appears to be using, on average, increasing levels of inpatient utilization. However, we are unable to extrapolate from these data any changes in the demographic composition of the population of uninsured children in Missouri.