Family MO HealthNet (MAGI) Manual – Table of Contents

1840.010.15.05 Affordable Insurance Definition

IM-#26, March 30, 2020, IM#86, May 29, 2019, IM#28, March 30, 2018IM#38, April 25, 2017IM#25, May 5, 2016IM-#23 April 26, 2016IM-#20 March 19, 2015

The affordability standard, outlined in RSMo Section 208.640, is based upon a percentage of income for a household of three at 150% (CHIP73), 185% (CHIP74), or 225% (CHIP75) of the FPL, depending upon the household’s gross income.

Households with income between 150% and 300% of the FPL with access to insurance must meet the following affordability guidelines:

  • For households with gross income above 150% up to and including 185% of FPL (CHIP73) the affordability standard is based upon a monthly premium amount of 3% of 150% of the FPL for a household of three (see Appendix I under CHIP program for current amount).
  • For households with gross income above 185% up to and including 225% of FPL (CHIP74) the affordability standard is based upon a monthly premium amount of 4% of 185% of the FPL for a household of three (see Appendix I under CHIP program for current amount).
  • For households with gross income above 225% up to and including 300% of FPL (CHIP75) the affordability standard is based upon a monthly premium amount of 5% of 225% of FPL for a household of three (see Appendix I under CHIP program for current amount).
  • NOTE: The affordability standard is updated each April if there are changes in the Federal Poverty Level.

NOTE: Consider all health insurance through employment with state agencies, where health insurance is available to their employees, as affordable regardless of the cost of the health insurance as compared to the affordability standards. See NOTE in Section 1840.010.10.05. 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.

If insurance is available for the child(ren) at a cost below the affordability standards, the child(ren) is not eligible for the MO HealthNet for Kids CHIP Premium coverage due to access to affordable health insurance. Refer to Section 1840.010.3, if the child(ren) has a pre-existing condition that the health insurance plan does not cover, or if the child(ren) has exceeded annual coverage for all healthcare services.