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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 - 39 - Objective 4: Improve the health of Missouri’s medically uninsured children through the use of preventive care. Performance goal: Assess how many children receive recommended well visits and screens. Baseline: As of Missouri State Fiscal Year 2006, the total number of eligibles receiving at least one initial or periodic screen was 275,101. Target Improvement Level: Increase the number of recommended well visits and screens received by children. Specific measurements of the target improvement levels for the four objectives are: 1. Continue to reduce the number of uninsured children in Missouri with an overall goal of reducing the total to less than 100,000. For reference, the number of uninsured children in Missouri (calculated on the basis of CPS data) fell to a low of 46,000 in 1999, but it subsequently increased to a high of 120,000 in 2004. We will monitor our progress towards this objective by reviewing the table published annually by the U.S. Census Bureau entitled “Historical Health Insurance Tables (Table HI-5): Health Insurance Coverage by State – Children under 18.” 2. Reverse the recent declines in enrollment in the existing 1115 Waiver program and increase total SCHIP 1 and SCHIP 2 enrollment. The State aims to achieve and maintain an overall combined enrollment target of 76,000 children in SCHIP 1 and SCHIP 2 by the end of Federal Fiscal Year 2008 (see attachment 10). For reference, existing 1115 Waiver enrollment has fallen from almost 74,400 in October 2005 to roughly 63,500 in April 2007. The State will monitor progress toward this objective by reviewing the Monthly Management Report published by the Missouri Department of Social Services, Family Support Division. 3. Reverse the recent declines in the number of children subject to premium payment in the program and maintain enrollment therein at or more than 20,000 children. With the imposition of the new premium structure over the last year, enrollment in the existing 1115 Waiver has decreased from over 30,000 in October 2005 to about 20,000 in April 2007. With additional outreach and education, the State will acclimate more families to the program and restore their enrollment, and attract new families to the program as an alternative to remaining uninsured. The State will monitor progress toward this objective by reviewing the Monthly Management Report published by the Missouri Department of Social Services, Family Support Division.