Family MO HealthNet (MAGI) Manual

1840.005.00 LEGAL BASIS (CHIP)

IM #22, March 7, 2017

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.

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:

  • NON PREMIUM GROUP: Gross income ABOVE 148% up to and including 150% FPL
  • PREMIUM GROUP:
    • Reduced Premium: Gross income over 150% up to and including 185% FPL
    • Reduced Premium: Gross income over 185%, up to and including 225% FPL
    • Full Premium: Gross income over 225%, and up to 300% FPL

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 than 3% for families whose income is greater than 185% FPL but does not exceed 225% FPL.

Senate Bill 577 (2007) enacted changes to the MO HealthNet 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 non-premium CHIP group to have prior quarter healthcare coverage eligibility explored (no sooner than September 1, 2007),
  • removes any penalty for dropping insurance for children in either the premium or non-premium CHIP groups,
  • 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.

Effective January 1, 2014, the Patient Protection and Affordable Care Act (PPACA or more commonly called the ACA) of 2010 requires Family MO HealthNet programs to use Modified Adjusted Gross Income (MAGI) methodology. The ACA removed net worth as a requirement.