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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 - 4 - SCHIP 1 Missouri proposes that uninsured children under age 1 with family income more than 185% but less than 300% of FPL and uninsured children age 1 through age 18 with family income between 151% and 300% of the federal poverty level be covered under a Separate Child Health Program. No new eligible is excluded because of pre-existing illness or condition. Children in families with income above 150% of FPL are not eligible if they have access to affordable insurance. Children eligible for SCHIP 1 receive a benefit package of essential medically necessary health services, excluding NEMT. This benefit is so unheard of in any health insurance plan that its inclusion serve as a significant incentive for dropping of private coverage. Prescription drugs are subject to the national drug rebate program requirements. Fee-for- service is utilized in regions where MO HealthNet Managed Care is not yet available. When MO HealthNet Managed Care begins in these areas, Title XXI eligibles will be enrolled in MO HealthNet Managed Care. A joint application is used to apply for the federal/state Title XIX and Title XXI programs. SCHIP 1 requires a premium, but does not impose co-payments, co-insurance, or deductibles. The program does not require an asset test. An asset test and a resource standard are the same. In Missouri, programs that have an asset test or resource standard compare the family’s available assets or resources to a standard. Certain assets or resources may be excluded when determining if the family’s assets or resources are below the maximum allowable to qualify for the program. Missouri does not have an asset test or resource standard for SCHIP 1. The net worth test for SCHIP 1 is $250,000. The net worth test for SCHIP 1 children in families with income that exceeds 150% of the Federal Poverty Level (FPL) is calculated by considering the value of all assets or resources minus any debt owed. There are no assets or resources excluded when determining net worth for SCHIP 1. SCHIP 1 requires children to be uninsured for six months prior to enrollment, except for children with special health care needs or when good cause for dropping insurance is found.