Family Healthcare (FAMIS)

0920.005.00 LEGAL BASIS (MC+)

IM-99 October 2, 2007,  IM-83 August 2, 2005,  IM-218 December 13, 2001

Section 208.151. 1. (12) RSMo beginning January 1, 1988, provides Title XIX coverage to a group of age-limited children with family income less than 100% of the federal poverty level.

SB 765 enacted changes effective July 1, 1990, providing Title XIX coverage to children under six years old with family income less than 133% of the federal poverty level and eliminating the resource factor of eligibility for Medicaid for Children programs.

The Omnibus Budget Reconciliation Act of 1990 (OBRA ’90) and House Bill 447 mandate Medicaid coverage to children, age six and over, born after September 30, 1983, up to age 19, if their family’s income is below 100% of the federal poverty level.

HB 564 enacted changes effective January 1, 1994, providing Title XIX coverage to children under one year old with family income less than 185% of the federal poverty level and eliminated the born after September 30, 1983 provision for coverage of children ages six through 18.

SB 632 enacted changes effective September 1, 1998 providing Title XIX coverage to uninsured children with family income over the previous limits up to 300% of the federal poverty level (FPL). The bill required cost sharing for higher income families in the form of co-payments and premiums. Children’s Health Insurance Program funds (Title XXI of the Social Security Act) and premium collections provide funding for this expansion of health care benefits. The bill divided the uninsured children into three eligibility groups:

  • NO-COST GROUP: Gross income up to and including 185% FPL
  • CO-PAY GROUP: Gross income over 185%, and up to and including 225% FPL
  • PREMIUM GROUP: Gross income over 225%, and up to 300% FPL

From February 1, 1999 through December 31, 2001 Missouri provided TXIX coverage to uninsured custodial parents whose family income is at or below 100% FPL. A Medicaid waiver under Section 1115 of the Social Security Act authorized this coverage. Effective January 1, 2002 this coverage was replaced by an expansion of the MAF program to cover parents (and other caretakers) with income at or below 100% FPL.

In June of 1999 Missouri began referring to the Medicaid program for all family eligibility groups as MC+.

Senate Bill 539 (2005) enacted changes effective September 1, 2005 to the MC+ for Kids healthcare coverage program (CHIP). The bill lowered the income limit for no-cost coverage and eliminated all cost-sharing except premiums. Under SB 539, uninsured children are divided into two eligibility groups, No-Cost and Premium.

Missouri Revised Statutes, Section 208.640 limits premiums and other cost-sharing to no more than 5% of a family’s income. House Bill 11 (2005) limits premiums to:

  • No more than 1% for families whose income does not exceed 185% FPL; and
  • No more then 3% for families whose income is greater than 185% FPL but des not exceed 225% FPL.

Senate Bill 577 (2007) enacted changes to the MC+ for Kids CHIP program. The bill allowed for uninsured children in families with gross income up to 150% FPL to meet all Title XIX program guidelines as defined under Optional Targeted Low Income Children (Social Security Act 1902(a)(10)(A)(ii)). This allows children in the No-Cost CHIP group to have prior quarter healthcare coverage eligibility explored (no sooner than September 1, 2007), removes any penalty for dropping insurance, eliminates assets as an eligibility factor and restores non-emergency transportation services. Uninsured children in families with gross income above 150% of FPL up to 300% of FPL are eligible for healthcare coverage under the State Children’s Health Insurance Program (SCHIP) under Section XXI of the Social Security Act.

If the Department of Mental Health (DMH) has custody or financial responsibility of the child, eligibility may be established under the guidelines of the MACC program outlined in Section 0955.000.00When DMH has custody or financial responsibility, there is no advantage to determining the child’s eligibility under MACC rather than MAF or MC+ for children. Any DMH child who would be eligible for MACC should be eligible under the MC+ for children program as non-CHIP. This is because if DMH only has financial responsibility and the parents retain legal custody, the parents’ needs and income must be included to determine MACC eligibility.