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• Effective September 1, 2007, the State created a Combination program by adding a new Separate Child Program (called SCHIP 1). Following is a chart depicting the CHIP eligibility coverage:

Amendments • On August 8, 2002, Missouri submitted its first CHIP State plan amendment (SPA). The amendment updated and amended the Title XXI State plan to indicate compliance with the final CHIP regulations.

• On July 1, 2004, Missouri submitted its second amendment to exempt children with special health care needs from the State’s 6-month period of uninsurance and from the 30-day waiting period.

• On May 31, 2007, Missouri submitted its third amendment which created a Title XXI Combination program, with a Separate CHIP component, MC+ for Kids program. Under the Separate program, uninsured children from birth to age 1, in families with income of more than 185 percent and up to and including 300 percent of the FPL are covered; and, age 1 through 18 with income of more than 150 percent of the FPL and up to and including 300 percent of the FPL are also covered. Under the Medicaid expansion, children from age 1 through 5, in families above 133 percent and up to and including 150 percent of the FPL are covered; and, those age 6 through 18 in families above 100 percent and up to and including 150 percent are also covered under the Medicaid Expansion program.

• On May 8, 2008, Missouri’s fourth CHIP SPA modified the eligibility requirements for targeted low income children to allow them to be eligible when they exceed their annual coverage limit and pre-existing conditions limit. It also changed the premium schedule effective July 1, 2008, through March 31, 2009, and replaced the dollar amounts of the affordability levels with the percentages applied to the effected FPLs. In addition the SPA changed the name of the State’s Separate Child Health Program to CHIP 1 and the Medicaid Expansion Program to CHIP 2. (Note: CMS disapproved this amendment on December 19, 2008.)

• On February 20, 2009, Missouri’s fifth CHIP amendment made several technical changes and clarifications to its CHIP State Plan as described below:

- Clarified the State’s current premium formula and modified its premium structure so that premiums are based on annual changes in the FPLs rather than providing specific amounts within the State Plan. This has not changed the amount of cost sharing that enrollees are currently charged.

Age FPL

Medicaid Expansion Separate CHIP Birth to 1 year

Above 185% - 300% 1 year thru 5 years Above 133% - 150% Above 150% - 300% 6 thru 18 years Above 100% - 150% Above 150% - 300%