Effective July 1, 2004, RSMo. 208.647 provided for the elimination of the following requirements for children with special healthcare needs who do not have access to affordable employer-subsidized health insurance. The six month penalty for loss of health insurance coverage without good cause; and The 30-day waiting period for children in the CHIP Full Premium Group (income above 225% FPL). Special healthcare needs are defined as a medical condition which left untreated would result in the death of or serious physical injury to a child. Special healthcare needs are established based on a written statement from the child’s treating physician. The Physician’s Statement (IM-60MC) form has been produced as a means of obtaining verification of the special healthcare needs. Evaluate the special healthcare needs exception to determine if the six month penalty should be imposed when: health insurance coverage was discontinued within six months prior to the date of application without good cause, the child(ren) has no access to affordable, employer sponsored healthcare coverage; and the parent/caretaker has indicated there is a child with special healthcare needs. Affordable employer sponsored healthcare is defined in Sections 0920.020.10.05 and 0920.020.10.10. Children in either of the premium groups (income above 150% FPL) are ineligible if they have access to any affordable health insurance, private or employer-sponsored. (Refer to Section 0920.020.10).
For CHIP Full Premium Group children (LOC 3 or CHIP75) who meet all other eligibility factors, the exception to the 30-day waiting period should be explored anytime a parent/caretaker has indicated a child has special healthcare needs.