Family Healthcare (FAMIS) Manual

0920.020.10 Access To Affordable Health Insurance

IM-69 November 21, 2014IM-01 January 4, 2012,  IM-34 April 23, 2008,  IM-#83 August 2, 2005

In addition to being uninsured, Premium group (income above 150% of FPL) children cannot have access to affordable health insurance. Access to affordable insurance available through employment, a group membership, or from a private company causes ineligibility. Examples of group memberships that could offer health insurance are a union, professional organization, or trade association. If the family fails to purchase the affordable health insurance, premium group children are ineligible as long as it is available. It is considered available even though there is a limited open enrollment period for which they need to wait.

EXAMPLE: Ms. Marks applies for MO HealthNet for Kids (MHK) for her children in July. Her gross income places coverage within the Premium Group. Ms. Marks became employed in February, and chose not to enroll her children in employer-sponsored insurance that is considered affordable. Her employer offers open enrollment every October with coverage beginning in January. Ms. Marks has access to affordable health insurance and is not eligible for MHK healthcare coverage.

Senate Bill 577 (2007) modified Section 208.640 RSMo to provide that employer sponsored health insurance and other health insurance that does not cover an eligible child’s pre-existing conditions are not considered affordable health insurance. The applicant/participant must provide verification from the health insurance plan that the plan does not cover the eligible child’s pre-existing condition and must provide verification from the child’s physician that the child has the pre-existing condition the health plan will not cover.

Additionally, Senate Bill 577 (2007) modified Section 208.640 RSMO to provide that an eligible child who has exceeded the annual benefits of his or her health plan for all healthcare services, is considered uninsured and does not have access to affordable health insurance.

House Bill 2014 (2008), signed by the Governor on April 22, 2008, provided funding to implement the provisions relating to pre-existing conditions and exceeding annual benefits for all healthcare services effective April 1, 2008.

NOTE: If the state employee is receiving premium assistance through the Health Insurance Premium Payment (HIPP) program, they still have access to affordable insurance and are ineligible for all CHIP levels of coverage.  HIPP payment of the premium is only an eligibility consideration when reviewing the factor of Uninsured and not when considering the eligibility factor of Access to Affordable Health Insurance