1840.010.00 Eligibility Requirements

1840.010.15.12 State Employee Health Insurance

IM-120 August 15, 2019; IM-77 June 27, 2017

Health insurance available to a state employee through a state agency is considered affordable regardless of cost. If the state employee is receiving premium assistance through the HIPP program, they still have access to affordable insurance and are ineligible for all CHIP premium levels of coverage.

Section 2110(b)(2)(B) of the Social Security Act (SSA) states children who have a family member eligible for health benefits coverage under a State health benefits plan on the basis of the family member’s employment with the State are not eligible for the Children’s Health Insurance Program (CHIP).

EXAMPLE: The Missouri Department of Transportation (MoDOT) is a state agency that does not participate in Missouri Consolidated Health Care Plan (MCHCP), however, provides health insurance to their employees.

Ms. Thompson applies for Family MO HealthNet for her two children and reports her employer as MoDOT. The expense of purchasing the MoDOT health insurance is $300.00 per month and therefore, the participant chose not to purchase the insurance. The participant’s household is uninsured. The participant is a state employee who can purchase health insurance through their state employer. The children are not eligible for CHIP level of care.

NOTE: Section 2110(b)(2)(B) of the SSA does NOT apply to non-CHIP Family MO HealthNet cases.

Not all individuals working for a state agency may be eligible to receive or purchase health benefits under a State health benefits plan. Some employment classifications may not be eligible to purchase health insurance through a State agency and should not be considered to have access to health benefits under a State health benefits plan.  These positions include but are not limited to:

  • temporary employees,
  • part time employees,
  • interns and
  • contract employees

EXAMPLE: A participant reports income from the State and electronic sources shows a temporary employment agency (i.e. Manpower, C&S Business Solutions, Job Finders, etc.).  The participant will need to clarify the source of income as they may have a job assignment with a state agency.  Clarification can be a verbal attestation.  The participant does not work directly for the State, therefore, does not have access to State Employee Health Insurance.

EXAMPLE: A participant reports income from another State Agency but lives in Missouri.  If electronic sources are not in conflict with participant’s attestation of employment, then consider the participant to have access to affordable health insurance regardless of the cost.

EXAMPLE:  A participant is a faculty member who works remotely from her home in Missouri at a university in Kansas.  That university is considered a state agency and offers the same health insurance to its faculty members that is available to other State of Kansas employees.  Because insurance for state employees is considered affordable regardless of the state, the participant is considered to have access to affordable insurance.

NOTE: If it is questionable if the employer is a state agency and if the household has access to State Employee Health Insurance, request a policy clearance (IM-14) through the appropriate supervisory channels.