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Missouri Application for the State Children’s Health Insurance Program Effective Date: 07/01/2011 Approval Date: Bold/Italics Added Information Prior Approval Date: 05/01/2009 Strikethrough Deleted Information - 44 - PMPM is calculated by the average monthly Total Costs divided by Member Months. Beneficiary Cost Sharing Payments The premium amount expected to be collected during FFY 2009 and FFY 2010. Based on the last year of historical cost sharing payments, the State expects a 2% annual trend. Children ages birth through 18 with family income between 150% and 300% FPL are required to pay a monthly premium. Net Benefit Cost Insurance Payments less Beneficiary Cost Sharing Payments. Administration Costs FFY 2009 expenditures include actual expenditures of the one quarter available and projected expenditures of the three quarters not yet available. Based on the last year of historical expenditures, the State is projecting an increase in administrative costs. The State expects administrative costs to grow approximately 2.0% annually.

Health Services Initiatives

Since we are requesting an effective date of July 1, 2011, the FFY 2012 expenditures include actual expenditures of the two (2) quarters available, projected expenditures of the two quarters not yet available, and the projected expenditures of the Health Services Initiative.

The source of expenditures for the Health Services Initiative is Local Public Health Agencies (LPHAs) who use Certifications of Public Expenditures (CPE) to demonstrate that the funds are local and state in origin.

Based on the last year of historical expenditures and the inclusion of the “Health Services Initiatives” the State is projecting an increase in administrative costs. The increase falls within the 10% Administrative Cost Ceiling. Please see Attachment 8.