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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: - 18 - Response: Crowd-out will be monitored by comparing the increase in MO HealthNet enrollment concurrent with the decrease in private insurance enrollment. The State of Missouri has implemented several safeguards against crowd-out, including a six-month waiting period and cost-sharing requirements. The application process for Missouri also has a number of other crowd-out deterrents built in. Although Missouri has taken several steps to simplify the application process by reducing the size of its application and accepting applications in the mail, it has also built more steps into the verification process than many states use to ensure that only applications from eligible individuals are accepted. For example, Missouri requires applicants with income between 150% and 300% of FPL to obtain two quotes from private insurers as proof that affordable insurance alternatives do not exist. In addition, children with incomes between 226% and 300% of FPL have a six-month penalty applied if they fail to pay required SCHIP 1 premiums and are not eligible for coverage until the six months expire. This penalty provision does not apply to those children between 150% and 225% of FPL who may fail to pay a required premium. There is a six-month waiting period for children who drop insurance without good cause, except for children with special health care needs. Children in families with income above 150% of FPL are not eligible if they have access to affordable insurance. In addition, families with income above 225% FPL have a 30 day waiting period before eligibility begins. In addition to monitoring the increase in MO HealthNet enrollment and the decrease in private insurance enrollment, the State will use data and information from several sources to further analyze whether the availability of SCHIP is the causative agent in the reduction of private insurance enrollment. Because the vast majority of private insurance, particularly for children, is employer-sponsored insurance the State will focus its analysis in this area. These additional data provide additional information about the number of business providing private health insurance to employees, the cost of such insurance to employees, the take- up rate of private employer-sponsored health insurance, and the labor market. The data are both national level and Missouri specific. Analysis of these data will allow the