MEMORANDUM

DISCUSSION:

This memorandum is to provide clarification of affordable employee-sponsored health insurance for families of state employees. Section 2110 of the Social Security Act states children who have a family member eligible for health benefits coverage under a State health benefits plan on the basis of the family member’s employment with the State are not eligible for the Children’s Health Insurance Program (CHIP).  If health insurance is available for children of state employees through Missouri Consolidated Health Care Plans (MCHCP) or another health insurance source through the State employer, regardless of the actual cost, the child has access to affordable health insurance.

As outlined in Income Maintenance memorandum IM-73 (2009) Access to Affordable Insurance and State Employee Health Insurance dated September 25, 2009, Missouri employer sponsored health insurance:

• Meets all of the requirements of employer-sponsored insurance as it meets the definition of affordable as the benchmark under 42 USC 1397jj;
• Meets the definition of health insurance; and
• Covers all of a child’s pre-existing conditions.

Therefore, if a state employee is eligible to purchase state health insurance for their family members, the family members have access to affordable insurance.  Children with access to affordable insurance are not eligible for coverage at either premium or non-premium CHIP level of care.

• NOTE: If the state employee is receiving premium assistance through the Health Insurance Premium Payment (HIPP) program, the children still have access to affordable insurance and are ineligible for all CHIP level coverage.  HIPP payment of the premium is only an eligibility consideration when reviewing the factor of Uninsured and not when considering the eligibility factor of Access to Affordable Health Insurance.

The manual is updated to reflect this clarification.

NECESSARY ACTION:

• Review this memorandum with appropriate staff

AC/df/mah