State Coverage Initiatives: State Profile: Missouri

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Group	Income Eligibility
Children	300% FPL
Pregnant Women	185% FPL
Parents	23% FPL
SSI Disabled	74% FPL

Medicaid, SCHIP, and Federal Authority ²

Section 1115 Waiver - In 1998, Missouri received approval from CMS to implement Missouri 's State Children's Health Insurance Program (SCHIP), MC+ For Kids, through a waiver under Section 1115 of the Social Security Act and a Title XXI plan. The approved Section 1115 Demonstration Waiver is a statewide program that provides MC+ to eligible children up to age 19 and some uninsured adults up to 300 percent FPL. The Section 1115 Demonstration Waiver allowed the state to expand eligibility to parents transitioning off welfare up to 300 percent of FPL as well as several other specific groups of parents. Effective July 1, 2002, coverage under the Section 1115 Demonstration Waiver was eliminated for uninsured non-custodial parents below 125 percent of FPL who were paying child support and uninsured non-custodial parents actively participating in Missouri 's Parents' Fair Share Program. Effective July 1, 2005, adults transitioning off welfare are no longer eligible for an additional year of coverage under Missouri 's Section 1115 Demonstration Waiver.

High-Risk Pool

The Missouri Health Insurance Pool (MHIP) was established by and operates according to legislation enacted in 1991. Although the MHIP is not an insurance company, it is supervised by the Missouri Department of Insurance. The MHIP is funded by premiums paid by its enrollees and assessments paid by health insurers and HMOs that issue coverage to Missouri residents. There is no limit on the number of individuals who may be enrolled in the MHIP.

The MHIP offers individual coverage through four major medical plans which differ only in the amount of the annual deductible and out-of-pocket maximums. Deductibles range from $500 to $5,000; out-of-pocket maximums range from $2,500 to $5,000. The maximum benefit payable on behalf of any individual during his or her lifetime under any plan or combination of plans the MHIP offers is $1,000,000 for all injuries and illnesses combined. At the end of 2005, approximately 2,800 persons were enrolled in the pool.


	Notes and Sources

Information presented in the profile was summarized in December 2006 from a review of state Web sites and reports, and through contacts with state officials. In most cases the profiles were reviewed by state officials; however, it is possible that states have implemented strategies that are not reflected in this profile.

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¹ This overview provides a general description of state coverage levels under their Medicaid and SCHIP programs, including coverage through waivers, as of October 2006. Health Management Associates researched eligibility information from state web sites, data from state reports, and verified through contacts with state officials during the fall of 2006. This does not reflect the specific eligibility categories or requirements. This is not intended to be a substitute for eligibility information provided by each state. Individuals interested in applying for these programs should contact the state directly for specific eligibility requirements.

² The profile only includes Medicaid and SCHIP waivers intended to make comprehensive expansions to the uninsured. At this time, the profiles do not include Family Planning, Pharmacy Plus waivers, or long-term care waivers.

³ Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on the Census Bureau's March 2005 and 2006 Current Population Survey.

⁴ Agency for Healthcare Research and Quality, Center for Financing, Access and Cost Trends. 2004 Medical Expenditure Panel Survey-Insurance Component.