Missouri Children's Health Insurance Changes

Jefferson City, Mo. - infoZine - The Department of Social Services' Division of Medical Services announced yesterday that it will not impose 1) a thirty-day waiting period after enrollment, or 2) a six-month waiting period for coverage when families with children eligible for the State Children's Health Insurance Program fail to pay a premium and their incomes are over 150% but less than 225% of the federal poverty level (FPL).



"What this means is that families responsible for the one percent or three percent premiums will not have to wait six months to be reinstated if for some reason they fail to make their premium payment. Reinstatement will occur as quickly as possible upon receipt of payment and the appropriate verifications. This will minimize the disruption in children's health insurance coverage," said Dr. Michael Ditmore, Director of Medical Services.



The state regulation as currently written can be read to apply the thirty-day waiting period after enrollment or the six-month waiting period for coverage to families with incomes between one hundred fifty percent and two hundred twenty-five percent of the FPL if they failed to pay premiums due to SCHIP by November 30. The Division of Medical Services is preparing a proposed regulation to limit these provisions to children in families with an income of more than two hundred twenty-five percent of the FPL.



"As written, state statute is silent to the extension of the thirty-day waiting period after enrollment and the six-month waiting period for coverage for children in families with incomes between one hundred fifty percent and two hundred twenty-five percent of the federal poverty level," said Billie Waite, attorney for the Division of Medical Services. "Division of Medical Services will be making the necessary modifications to ensure that the state regulation is in precise alignment with the statutory language."



The thirty-day waiting period and the six-month waiting period for failure to pay a premium have been a part of SCHIP since its inception for families with incomes over two hundred twenty-five percent of poverty. The latter provision was designed as a deterrent to discontinuing employer sponsored coverage in favor of Medicaid.



SCHIP families formerly had co-payment responsibilities, which were dropped in favor of the premium approach under current law. The Division of Medical Services gave families from September 1 to September 30 to pay their first premium so that coverage could continue uninterrupted. If families did not pay their premium by September 30 coverage for their children stopped, but cases remained open for a sixty-day grace period. On September 1, approximately 27,000 families owed premiums for over 48,000 children. As of October 25, payments were outstanding for about 12,300 children.



The Department is reinstating coverage for these children immediately upon receipt of payment and urges families to continue to make the premium payments as quickly as possible. For a family of four with two children making about $30,000 a year, the premium is $12.00 a month per child for full health insurance coverage. After paying the premium, the family has no further out of pocket expenses. "It is not unreasonable for families with incomes at this level to bear some responsibility for the cost of their children's care. This is reasonable, affordable health care coverage and a good investment for parents and caregivers in their children's health. We certainly hope families will take advantage of this affordable coverage," Ditmore added.