| TO: | ALL COUNTY OFFICES |
| FROM: | JANEL R. LUCK, DIRECTOR |
| SUBJECT: | CHANGES TO MC+ FOR CHILDREN'S HEALTH INSURANCE (CHIP) PROGRAM MANUAL REVISION #36: 0920.005.00, 0920.010.00, 0920.020.00, 0920.020.05, 0920.020.05.15, 0920.020.05.20, 0920.020.15, 0920.020.15.05, 0920.020.30, 0920.020.30.05, 0920.030.00, 0920.030.05, 0920.030.10 |
DISCUSSION:
On September 28, 2007, the Center for Medicare and Medicaid Services (CMS) approved a new State Children's Health Insurance Program (SCHIP) plan for Missouri to allow the changes authorized in SB 577 (2007). The bill made no changes to the state's requirements for coverage of uninsured children in families with gross income above 150% of the federal poverty level (FPL) up to 300% of FPL. The following changes are effective September 1, 2007, for uninsured children in families with gross income not exceeding 150% FPL (LOC 1 in the legacy system, CHIP0 in FAMIS):
- beginning date of eligibility is the first of the month of application (or the first of the following month, if not eligible in month of application);
- prior quarter coverage is available, but not prior to 9/1/07;
- there is no penalty for dropping insurance;
- the requirement to have net worth of $250,000 or less no longer applies; and
- these children are eligible to receive non-emergency medical transportation (NEMT).
Legal Basis
Senate Bill 577 (2007) enacted changes to the MC+ for Kids CHIP program. The bill allows coverage for uninsured children in families with gross income up to and including 150% of the federal poverty level (FPL) to be based on all the requirements and guidelines of Title XIX of the Social Security Act. Uninsured children in families with gross income above 150% of FPL up to 300% of FPL are eligible for a healthcare plan under the State Children's Health Insurance Program (SCHIP) under Title XXI of the Social Security Act. Previously all CHIP children in Missouri were covered under a Title XIX expansion through a Section 1115 Waiver of the Social Security Act, which allowed restrictions to certain Title XIX requirements. Effective September 1, 2007, the federal bases for Missouri's coverage of CHIP children are:
- for uninsured children in families with gross income not exceeding 150% of FPL, a Title XIX expansion to cover Optional Targeted Low Income Children under Section 1902(a)(10)(A)(ii)(XIV) of the Social Security Act.
- for uninsured children in families with gross income that exceeds 150% of FPL up to 300% of FPL, a healthcare plan under the State Children's Health Insurance Program (SCHIP) under Title XXI of the Social Security Act.
NOTE: There are no changes in benefit package or how children access their coverage for uninsured children in families with gross income that exceeds 150% of FPL up to 300% of FPL under SCHIP.
Eligibility Changes
Families must continue to meet the eligibility requirements below for all MC+ for Kids SCHIP participants:
- Social Security Number
- Age of child
- Residence
- Citizenship and alien status
- Assignment of medical support
- Cooperation in pursuit of medical support
- Need
- Uninsured
NOTE: Families with gross income up to 150% FPL (Legacy Level of Care 1, FAMIS CHIP0) no longer are subject to the net worth test of $250,000 or have a resource limit.
Families with gross income over 150% FPL and up to 300% FPL (Legacy Levels of Care 2 and 3, FAMIS CHIP73, CHIP74 and CHIP75) must continue to meet the following additional eligibility criteria:
- Access to affordable health insurance;
- Net worth of $250,000 or less;
- Payment of premium; and
- Uninsured for 6 months.
Beginning Date of Coverage: Previously, children eligible for LOC1/CHIP0 were determined eligible no sooner than date of application. Effective September 1, 2007, if a child is determined eligible the month of application, eligibility begins on the first day of the month. Prior quarter eligibility is also to be determined, if requested. Eligibility based on prior quarter cannot start before September 1, 2007.
Example: Ms. Jones applies for MC+ for children coverage for her child Tom on October 15, 2007. It is determined that Tom is eligible for the non-premium CHIP group (LOC 1/CHIP0) for month of application and for the prior quarter (July through September, 2007). Eligibility for Tom begins September 1.
Children eligible for CHIP premium coverage with income not exceeding 225% of FPL (LOC 2/CHIP73/CHIP74) continue to be eligible beginning the date of application, or first of the following month if not eligible for the application month. Children eligible for CHIP premium coverage with income above 225% of FPL (LOC 3/CHIP75) continue to be eligible 30 days from the application date (date of application for children determined to have special healthcare needs). Coverage for the premium groups does not start until the premium payment is received.
Dropping Insurance: Children eligible for the non-premium CHIP group (LOC 1/CHIP0) are no longer subject to a penalty period of ineligibility for dropping insurance. Children must be uninsured to be eligible. Refer to Family Medical Assistance Manual Sections 0920.020.05 and 0920.020.05.10 for information regarding insurance status.
Example: Mr. and Mrs. Apple apply for MC+ for children coverage for their child John on October 3. It is determined that John is eligible for the non-premium CHIP group (LOC 1/CHIP0). Mr. Smith quit his job September 20 and lost his child's healthcare insurance effective October 15. John is eligible for the non-premium CHIP group (LOC 1/CHIP0) as of October 15, the day he is not insured and meets all other eligibility criteria. John is not subject to a penalty period for having dropped insurance without good cause.
Children eligible for any premium group continue to be subject to the penalty period for having dropped insurance without good cause (special healthcare needs exception applies).
Non-Emergency Medical Transportation: Children eligible for the non-premium CHIP group (LOC 1/CHIP0) are eligible to receive non-emergency medical transportation (NEMT) benefits effective immediately. Children eligible for any premium group remain ineligible for NEMT.
NECESSARY ACTION:
- Review this memorandum with appropriate staff.