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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: - 3 - Section 1. General Description and Purpose of the State Child Health Plans and State Child Health Plan Requirements (Section 2101) 1.1 The State will use funds provided under Title XXI primarily for (check appropriate box): (42 CFR 457.70) 1.1.1 □ Obtaining coverage that meets the requirements for a separate child health program (Section 2103); OR 1.1.2 □ Providing expanded benefits under the State’s Medicaid plan (Title XIX); OR 1.1.3  A combination of both of the above. Response:

1. Separate SCHIP Program 2. Medicaid Expansion Program As a result of the passage of Senate Bill (SB) 577 during Missouri's 94th Legislative Session in 2007, Missouri's Medical Assistance Program, formerly 1SCHIP 1: Children under age 1 Children in families with gross incomes of more than 185% but less than 300% FPL 1SCHIP 1: Children ages 1 through 5 Children in families with incomes of more than 151% but less than 300% FPL 2SCHIP 2: Children ages 1 through 5 Children in families with incomes more than 133% but less than 151% FPL 1SCHIP 1: Children ages 6 through 18 Children in families with incomes of more than 151% but less than 300% FPL 2SCHIP 2: Children ages 6 through 18 Children in families with incomes of more than 100% but less than 151% FPL