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Missouri Application for the State Children’s Health Insurance Program Effective Date: 09/01/2007 Approval Date: 09/28/2007

Prior Approval Date: - 6 - Section 2. General Background and Description of State Approach to Child Health Coverage and Coordination (Section 2102 (a)(1)-(3)) and (Section 2105)(c)(7)(A)-(B)) 2.1 Describe the extent to which, and manner in which, children in the State including targeted low-income children and other classes of children, by income level and other relevant factors, such as race and ethnicity and geographic location, currently have creditable health coverage (as defined in 42 CFR 457.10). To the extent feasible, make a distinction between creditable coverage under public health insurance programs and public-private partnerships (See Section 10 for annual report requirements). (42 CFR 457.80(a)) Response: Information regarding age, income, coverage by other health insurance, and location is currently available from Missouri’s Application for Benefits and will be required for Title XXI applicants. The State will require that any recipient cooperate fully with the state and federal government in establishing eligibility and in providing any verification necessary as requested by the State in the initial application process or at any subsequent time. Title XXI recipients will have distinct ME codes for tracking purposes. Please see Attachment 1. Unfortunately, the extant data is quite limited. We summarize the available data below:  Missouri does not conduct its own recurring prevalence study for health insurance among resident children. However, the Missouri Department of Health and Senior Services (DHSS) commissioned a study in 2004 under a State Health Planning Grant from the Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services (DHSS). This study, the Missouri Health Care Insurance and Access (MHCIA) survey, asked questions regarding health insurance coverage of roughly 7,000 respondents. The survey found that the rate of uninsurance among Missouri children under age 19 was 3.4 percent (no standard error or confidence interval reported). The MHCIA study also reported a slightly higher rate (4.0 percent) among children in households with incomes below 300 percent of the federal poverty level. However, the sample size was too small to generate meaningful rates for additional subpopulations. The MHCIA report noted that, “Missouri’s public programs cover a larger proportion of children (28.5%), while rates of group (63.9%) and individual coverage (4.2%) for children are similar to the rates of the adult population.” The one-year nature of the study prohibits any trending or longitudinal analyses. For additional information, see http://www.dhss.mo.gov/DataAndStatisticalReports/Missouri_Final_Report.pdf. Note: The Missouri Foundation for Health analyzed and compared