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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 - 36A - SCHIP 1 participant Hearing Rights. If they request a hearing within ten days of the date of the notice, they will continue to receive benefits. Once the recipient receives an adverse action notice they can call, write, or email to request a hearing. Once the hearing request is received the recipient is mailed a Hearing Packet which must be completed and returned. When the Hearing Packet is returned, the Hearing Unit with the Division of Legal Services (DLS) is notified. DLS sets the time and date for the hearing. The recipient can present evidence or have someone testify on their behalf. The DLS Hearing Officer asks all the questions, and the recipient and the DLS Hearing Officer are given the opportunity to respond and present evidence. After the hearing is complete the DLS Hearing Officer makes a decision based on the evidence presented. Once the decision is complete all parties are notified and whatever action is taken. 8.8 The State assures that it has made the following findings with respect to the payment aspects of its plan: (Section 2103(e)) 8.8.1  No Federal funds will be used toward state matching requirements.(Section 2105(c)(4)) (42 CFR 457.220) 8.8.2  No cost-sharing (including premiums, deductibles, copays, coinsurance and all other types) will be used toward state matching requirements. Section 2105(c)(5) (42 CFR 457.224) (Previously 8.4.5) 8.8.3  No funds under this title will be used for coverage if a private insurer would have been obligated to provide such assistance except for a provision limiting this obligation because the child is eligible under the this title.(Section 2105(c)(6)(A)) (42 CFR 457.626(a)(1)) Response: 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.