FROM: KIM EVANS, DIRECTOR
SUBJECT: NEW CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP) NON-PREMIUM LEVEL OF CARE, 4M
MANUAL REVISION #
1800.000.00
1805.030.15
1805.040.00
1840.010.00
1840.010.05
1840.015.00
1880.010.00
1885.000.00
MAGI Appendix A
MAGI Appendix D
MAGI Appendix H
DISCUSSION:
CHIP 4M Non-Premium is a new level of care (LOC) effective July 1, 2022 created for MO HealthNet Division (MHD) reporting requirements. CHIP 4M provides non-premium MO HealthNet coverage for uninsured children who meet the requirements at 1840.010.00 Eligibility Requirements in addition to the following:
Income
- Children ages 1 through 5: Gross income of 148% up to and including 153% FPL
- Children ages 6 through 18: Gross income of 110% up to and including 153% FPL
Family MO HealthNet (MAGI) Manual Appendix A and Appendix D are updated with this change.
Uninsured
- Children must be uninsured with no access to health insurance through a family member’s employment with a public agency.
- Children with disabilities who qualify for MO HealthNet for Disabled Children (MHDC) non-spend down are considered insured.
Children are eligible for MO HealthNet for Kids (MHK) Non-CHIP if they meet all eligibility factors for CHIP 4M, other than the uninsured requirement. Explore MHK coverage if a child on CHIP 4M becomes insured or otherwise fails to meet the uninsured requirements for the CHIP 4M group.
EXAMPLE: Shari, age 13, receives CHIP 4M coverage. Her household’s income is at 117% of FPL. Her mother reports that Shari is now receiving health insurance coverage through an employer. Shari’s coverage transitions to MHK Non-CHIP.
Do not close or reject CHIP 4M coverage for failure to provide information about insurance status for a child.
EXAMPLE: June is uninsured and is eligible for CHIP 4M coverage. Her father submits two applications, one on 7/1 and the other on 7/2. On the 7/1 application he declares that June has insurance through his employer. On the 7/2 application he declares that she is uninsured. Clarification of insurance status for June is requested, but her father does not respond. June remains eligible for CHIP 4M.
Eligibility for CHIP 4M begins the first day of the application month or in prior quarter if all eligibility requirements are met. Children eligible for CHIP 4M are eligible for Non-Emergency Medical Transportation (NEMT).
MXIX will display 4M in the LOC column, when applicable. MAGI Appendix H: ME Codes Chart is updated with CHIP 4M.
NOTE: Although 4M is CHIP, because its income guidelines overlap with non-CHIP, the assignment of medical support is mandatory. A Referral/Information for Child Support Services (CS201) is required unless good cause for refusal to cooperate is established. Refer to 1805.040.00 Cooperation in Pursuit of Medical Support.
The MAGI manual is updated with these changes.
NECESSARY ACTION:
- Review this memorandum with appropriate staff.
KE/ers
