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Missouri Application for the State Children’s Health Insurance Program Effective Date: 05/01/2009 Approval Date:

Prior Approval Date: 09/28/2007 - 15A - provide it. The claimant is informed about reporting requirements and that it is against the law to obtain benefits to which they are not entitled. FSD staff provides information about income guidelines and the eligibility criteria as well as time limits for processing an application. FSD requires documentation of citizenship or immigration status for eligible children and verification of the family’s income. FSD does not have a durational requirement for residency. The eligible family members must state they are Missouri residents. It is important to note that the State is concerned that SCHIP 1 does not “crowd out” private insurance options. The following measures will help address crowd out of private insurance options: • There will be a six month look back period for health insurance when determining eligibility. Children whose parents’ available private health insurance coverage was dropped within the last six months will have a six month waiting period under SCHIP 1. Uninsured is defined as a child (children) under age 19 who does not have creditable health insurance coverage as described at 42 CFR 457.10 and 45 CFR 146.113 that minimally provides coverage for physician’s services and hospitalization. The six month look back applies. To be eligible for SCHIP 1, the child must be uninsured. • Uninsured children are children under age 19 who do not have creditable health insurance coverage as described at 42 CFR 457.10 and 45 CFR 146.113. A child covered by health insurance at the time eligibility is determined is ineligible unless the insurance is already paid for by Missouri’s Health Insurance Premium Payment Program (HIPP). If the health insurance is dropped without good cause or the child does not have a special healthcare needs exception, the child is ineligible for six months from the month coverage ended. • The six month look back period refers to the six months prior to application. If an uninsured child lost or dropped insurance coverage in the six months prior to application, FSD explores if the reason the child is uninsured meets a good cause reason or if the child meets a special healthcare exception. • Good cause is defined as loss of insurance coverage resulting from no action taken by the insured. Good cause reasons are: • A parent's or guardian's loss of employment due to factors other than voluntary termination; • A parent's or guardian's employment with a new employer that does not provide an option for dependent coverage; • Expiration of a parent's or guardian's dependent Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage period;