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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 - 15B - • Lapse of a child's (children's) health insurance when maintained by an individual other than custodial parent or guardian; • Lapse of a child's (children's) health insurance when the lifetime maximum benefits under their private health insurance have been exhausted; • Lapse of a child's (children's) health insurance when the health insurance plan does not cover an eligible child's preexisting condition; or • Discontinuance of Health Insurance Premium Payment (HIPP). • For children in families with gross income above 225% of the FPL there is a 30 day waiting period from the date of application for coverage. The 30 day waiting period does not apply to children and families with gross income below 225% FPL. These children under 225% of the FPL shall not be subject to the 30-day waiting period as long as the children meet all other qualifications for eligibility. • Any child identified as having special health care needs, defined as a condition which left untreated would result in the death or serious physical injury of a child, that does not have access to affordable employer- subsidized health care insurance will be exempt from the requirement to be without health care coverage for six months in order to be eligible for services, and the 30-day waiting period as long as the child meets all other qualifications for eligibility. Special healthcare needs are established based on a written statement from the child’s treating physician. • Children with special healthcare needs must still be uninsured to qualify and cannot have access to affordable health insurance. Access to affordable insurance available through employment, a group membership, or from a private company causes ineligibility. The affordability guidelines are: • Three percent of 150% of the FPL for a family of three, for families with a gross income of more than 150% and up to 185% FPL. • Four percent of 185% of the FPL for a family of three, for families with a gross income of more than 185% and up to 225% FPL. • Five percent of 225% of the FPL for a family of three, for families with a gross income of more than 225% but less than 300% FPL. • Children in families with gross income above 150% of the FPL cannot have access to affordable employer sponsored or private health insurance. These children must pay a premium to be eligible (a cost sharing provision). The following is a description of the affordability test: • Three percent of 150% of the FPL for a family of three, for families with a gross income of more than 150% and up to 185% FPL. • Four percent of 185% of the FPL for a family of three, for families with a gross income of more than 185% and up to 225% FPL. • Five percent of 225% of the FPL for a family of three, for families with a gross income of more than 225% but less than 300% FPL.