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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 - 42A - Eligible To Receive Services From the United States Bureau of Indian Affairs” (Vol. 72, No. 55 / Thursday, March 22, 2007). • The Eastern Shawnee Tribe of Oklahoma (http://www.easternshawnee.org/index.html and http://www.eighttribes.org/eastern-shawnee/) listed above is actually centered on the Oklahoma/Missouri border. • Article II of the Constitution of the Eastern Shawnee Tribe (http://thorpe.ou.edu/constitution/eastshawcons.html) states that “...Eastern Shawnee lands, which are located in the north east section of the State of Oklahoma, and such other territory as may hereafter be added thereto.” This evidence is fully consistent with the CMS' position that Missouri has no federally- recognized American Indian/Native American tribes within the state. Recognizing that a member of a tribe may re-locate to the State, Missouri will exempt children who are members of federally-recognized tribes from cost-sharing requirements as stipulated in Section 2103(e)(1)(A). Children who identify themselves as American Indian or Native Alaskan on the SCHIP application will be notified that, upon receipt of documentation of tribal membership, they will no longer be required to submit monthly premiums. Any premiums paid will be reimbursed within 45 days of receipt of documentation of tribal membership. The materials sent to all new enrollees will include information on the cost-sharing exemption for members of federally-recognized American Indian or Native Alaskan tribes to ensure that those not indicating race on the application will be notified of this exemption. 9.9.2 For an amendment relating to eligibility or benefits (including cost sharing and enrollment procedures), please describe how and when prior public notice was provided as required in part 457.65(b) through (d). Response: The Missouri General Assembly holds a series of public hearings in conjunction with the approval of the annual budget for Missouri and as they consider changes in State law. Once the hearings are complete and the budget has been approved, the premium amounts are calculated. A notice is mailed to affected individuals 30 days prior to implementation of changes. A monthly invoice is mailed to participants thirty days in advance, billing them for the next month's premium. The premium chart and information regarding premiums is posted on the Department of Social Services' website and in outreach and educational materials. Public Notice is also provided through amendments to 13 CSR 70-4.080, State Children's Health Insurance Program, published in the Missouri Register with a 30 day public comment period.