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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 - 20C - • 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; • 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. • 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.