1840.010.00 Eligibility Requirements

1840.010.15.20 Special Healthcare Needs

Effective July 1, 2004, RSMo. 208.647 eliminated the 30-day waiting period in the CHIP75 Premium Group for children with special healthcare needs that do not have access to affordable employer sponsored health insurance.

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. Self attestation may be accepted for special healthcare needs.

Evaluate the special healthcare needs exception when:

  • the child(ren) has no access to affordable private or 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 1840.010.15 Access to Affordable Health Insurance and 1840.010.15.10 Employer Sponsored Insurance. Children in any of the premium groups (income above 150% FPL) are ineligible if they have access to affordable health insurance, private or employer sponsored. Refer to Section 1840.010.15 Access to Affordable Health Insurance.