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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 - 20B - interagency meetings, provider association contacts, and the Managed Care Consumer Advisory Committee. Missouri continues to outstation Eligibility Specialists at some hospitals and federally qualified health centers. Missouri continues agreements that allow federally qualified health centers and local public health agencies to accept applications on behalf of the FSD. The State will explore the effectiveness of expanding the sites for enrolling children in a wider variety of community settings with the Managed Care Consumer Advisory Committee, advocates for children, and health care providers. The State will also be cooperating with the Missouri Hospital Association in their efforts to develop an effective outreach program for MO HealthNet children. We will also partner with local community groups and agencies which want to sponsor local outreach initiatives. Income will be determined by looking at the total gross income available to the children for whom the application is being made. The current assistance group definitions used by Missouri for MO HealthNet budgeting will be followed. A standard income disregard equal to 100% of the FPL will be made from the gross income figure. The net income figure will be compared to 200% of FPL to determine if the child(ren) is (are) eligible. To be eligible, this net figure must not exceed 200% of FPL for children. There are no other disregards for SCHIP 1 children. An assistance group is comprised of the child for whom benefits are being requested and his or her biological or adoptive parents if living together in the same household. 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