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- Provided greater detail and clarified the State’s premium assistance program and correctly indicated that Missouri has a Purchase of Family Premium Assistance Program. Prior to this SPA it was unclear that the State provided premium assistance to its Separate Child Health Program enrollees.

- Changed Missouri’s CHIP State Plan Program name to SCHIP 1 for its Separate Child Health Program and SCHIP 2 for its Medicaid Expansion Program.

• On August 19, 2009, Missouri’s sixth CHIP amendment exempted temporary income earned while working for the decennial census from the eligibility calculations for CHIP new applicants and enrollees at redetermination.

• On June 3, 2011, Missouri’s seventh CHIP amendment proposed to provide CHIP coverage to children of public employees. (Note: The State withdrew this amendment on June 29, 2011.)

Children Covered Under the Program In Federal Fiscal Year 2010, Missouri reported 141,236 children were ever enrolled in CHIP, of that total 86,201 were in its Separate CHIP and 55,035 were in the Medicaid Expansion Program.

Administration The program is administered by the State Medicaid Agency within the Missouri Department of Social Services.

Health Care Delivery System and Benefit Package Children eligible under the Medicaid Expansion program receive the Title XIX health care benefit package. Children eligible under the Separate CHIP program receive the Medicaid benefit package with the exception of non-emergency transportation. Coverage for CHIP enrollees is provided through the managed care delivery system in the 54 counties in which Missouri’s Section 1915(b) waiver operates. In the remaining counties, CHIP coverage is provided through a fee for service system.

Cost Sharing • No cost sharing is charged for the Medicaid Expansion enrollees, but the Separate CHIP enrollees are charged premiums based on family income. (The State’s computer system does not allow an enrollee to pay more than 5 percent of its family's gross income on premiums.)

• Missouri uses a premium formula structure outlined by its State Legislature as follows:

- Children with family incomes between 150 percent and 185 percent of the FPL are charged a premium of 4 percent of their family income.