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Medicaid, SCHIP, & Federal Authority

  • In 2007, Missouri embarked upon a transformation of its Medicaid program into MO HealthNet, with the vision of creating a model for the provision of high-quality health care focused on wellness.  As part of this reform initiative, in October 2007, Missouri transitioned its comprehensive Section 1115 waiver program to a State Plan State Children’s Health Insurance Program (SCHIP) combination program with a separate SCHIP component. The combination program continues to provide benefits to eligible children up to age 19 with incomes up to 300 percent of the federal poverty level (FPL), primarily under a managed care delivery system. 

    Through a new Section 1115 family planning waiver, the State continues to provide Women's Health services for up to one year to uninsured post-partum women ages 18 to 55 who are losing Medicaid eligibility 60 days after their child’s birth. Missouri will be modifying the 1115 Family Planning Waiver to include women 18 to 55 years of age with net income of less than 185% of the Federal Poverty Level. 


High-Risk Pools

  • 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.