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Children's Health Insurance in Missouri
by R. E. Peters
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Overview
Congress amended the Social Security Act in 1997 to establish the State Children's Health Insurance Program (SCHIP). This program offers health insurance coverage to children from families with incomes that exceed the eligibility requirements for Medicaid, but who cannot afford private health insurance coverage. Missouri recast its Medicaid program in 2007 into MO HealthNet to provide health care to eligible individuals. As part of this transition, Missouri established MO HealthNet for Kids to provide health care both for children who are eligible for Medicaid coverage and for uninsured low-income children under the SCHIP program.
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Eligibility
In order to be eligible for MO HealthNet for Kids coverage, a child must be under age 19, must have applied for a Social Security number and must be either a U.S. citizen or a qualified eligible non-citizen. A child born in the United States is a citizen, and may be eligible for MO HealthNet for Kids without regard to the parents' citizenship. In addition, the income of the child's family must meet the income guidelines for MO HealthNet for Kids participation.
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Income Guidelines
The Medicaid component of MO HealthNet for Kids offers health care coverage for children without regard to their insured or uninsured status if the monthly net family income does not exceed 185 percent of the federal poverty level (FPL) for children under age 1, or 133 percent of the FPL for children ages 1 to 5, or 100 percent of the FPL for children ages 6 to 18. In addition, uninsured children whose family's monthly gross income is less than 150 percent of the FPL are also eligible for this component of MO HealthNet for Kids.
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SCHIP Eligibility Guidelines
Uninsured children with a family income that is greater than the income guidelines for the Medicaid component of MO HealthNet for Kids may be eligible to participate in the SCHIP component of MO HealthNet for Kids. The Missouri SCHIP program provides coverage to a child whose gross family income is more than 150 percent of the FPL but does not exceed 300 percent of the FPL. The child must have been uninsured for six months and the family's net worth cannot exceed $250,000. In addition, the family must be without access to affordable health care coverage, which is defined as coverage available at $69 to $172 per month, based on the family's income and size.
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SCHIP Premiums
The families of children who participate in the SCHIP component of MO HealthNet for Kids pay a monthly premium. The amount paid per family varies according to the size and income of the family. Changes in family income or size must be reported to the Family Support Division of the Missouri Department of Social Services within 10 days. The premium amounts are adjusted annually in July. The premium schedule is intended to ensure that a family does not pay more than 5 percent of its income in premiums. If a family's out-of-pocket health care expenses reach 5 percent of annual income, the family will not be required to pay the SCHIP program premium for the remainder of the year.
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Coverage
The MO HealthNet for Kids program provides coverage for medically necessary services. The Medicaid component and the SCHIP component of the program provide the same level of coverage, except that SCHIP coverage does not include non-emergency medical transportation. Services that are covered by MO HealthNet for Kids include primary, acute and preventive care; hospital care; and speech, physical and occupational therapy. The program also provides coverage for vision and dental care; laboratory, X-ray and pharmacy services; medical supplies and equipment; home- or community-based medical services such as nursing care; and sports physicals.
Depending upon where in Missouri the children live, the participants in MO HealthNet for Kids receive medical services either on a fee-for-service (FFS) basis, or through a managed care system.
