Family MO HealthNet (MAGI)

1840.010.10 Uninsured

IM #22, March 7, 2017

Per Missouri State Statue, RSMo Section 208.631.1, health care must be made available to uninsured children whose household income falls within any of the CHIP groups (premium or non-premium), 150% to 300% of the FPL.

NOTE:  Prior to July 1, 2014 children must have been uninsured for six (6) months.  Senate Bill 754 (2014) removed the penalty for dropping insurance for both premium and non-premium CHIP groups.

Uninsured children are defined as any person up to nineteen years of age and:

  • emancipated and do not have access to affordable employer sponsored insurance, or
  • does not h ave other health care coverage,

NOTE:  Uninsured children must also meet Missouri residency requirements as well as all other financial and non-financial MO HealthNet eligibility criteria.

A child covered by health insurance at the time of CHIP eligibility is considered ineligible unless the insurance is one of the following:

  • Short Term Insurance
  • Accident Insurance
  • Fixed Indemnity Insurance
  • Limited Coverage Insurance
  • Credit Insurance
  • Coverage issued as a supplement to liability insurance
  • Insurance arising out of a workers’ compensation insurance or similar law.
  • Automobile Medical Payment Insurance
  • Insurance under which coverage is payable with or without regard to fault  of an individual and which is required by statue to be contained in any liability insurance policy or equivalent self-insurance policy
  • The Caring Foundation for Children Program
  • The insurance enrollment is already paid for by the Health Insurance Premium Payment  (HIPP) Program
  • An eligible child who has exceeded the annual or lifetime coverage maximums of his or her health plan for all healthcare services
  • NOTE: Persons who have exceeded an annual or lifetime maximum for all coverage under their plan are considered uninsured. The applicant/participant must provide verification from his or her health plan that the child has reached the annual/lifetime maximum for all plan coverage. The verification must provide a date if healthcare coverage will  be reinstated  for the child. The E ligibility Specialist must update the evidence in MEDES annually.

    NOTE: A disabled child who is eligible for non-spend down MO HealthNet for Disabled Children (MHDC) is considered insured and is ineligible to receive CHIP coverage.  A disabled child who is eligible for spend down MHDC is considered uninsured and would be potentially eligible for CHIP coverage.

To determine insurance affordability refer to MAGI Policy Manual sections 1840.010.15 Access to Affordable Health Insurance and 1840.010.15.05 Affordable Insurance Definition.