LOCAL INVESTMENT COMMISSION

3100 BROADWAY, SUITE 226

KANSAS CITY, MO  64111

(816)889-5050

www.kclinc.org

6/16/98



The Childrenās Health Insurance Program 



Why is it being discussed?



What this means for Missouri and Kansas City?





The State Childrenās Health Insurance Program (CHIP) was created by the US 

congress as part of the Balanced Budget Act of 1997.  Through CHIPs, the 

federal government gives each state a pool of money to be used to provide 

uninsured children with health insurance.  CHIPs specifically targets providing 

coverage to children that do not qualify for Medicaid but whose families cannot 

afford the cost of private health insurance.



Facts about the Federal Program



  The US CHIPs budget provides up to $20.3 billion in grants over the next 5 

years to states.

  US CHIPs covers children ages 18 and younger unless a state receives 

waivers to cover parents and other working adults too.

  During years 1-3, states receive a federal allotment of funds based on the 

number of low-income, uninsured children in the state.  During years 4-5 the 

federal allocation formula changes to give greater weight to the number of 

low-income children in a state regardless of whether or not they have health 

insurance.

  In order for states to obtain the federal CHIPs funds, they must contribute 

matching funds.  The match portion states must provide ranges from 16% to 

35%.  This range of state matching funds is smaller than the state medicaid 

match required.

  Eligibility for the US CHIPs is limited to families with incomes under 200% of 

the federal poverty line unless a stateās Medicaid income limit for a particular 

group of children is already higher than 150% of the federal poverty line.  In 

these states the income eligibility criteria may be higher.



Facts about the Proposed Missouri Program



The Missouri CHIPs will be implemented as a multi-step process through the 

governorās office and the Missouri legislature.  The first step of the process was 

for the governorās office to request access to the program from the US 

Department of Health and Human Services.  Governor Carnahanās office chose 

to ask for a waiver (Missouri Medicaid 1115 Waiver) that would allow Missouri to 

expand the current Medicaid program.  Funding for the total waiver is $151.8 

million.  This includes $102 million in new federal funds.





The Missouri CHIPs would provide the following benefits:

¬ Children would receive the current MC+ package of medically 

necessary services with the exception of non-emergency medical 

transportation.

¬ Adults will receive a package roughly comparable to that offered State 

of Missouri Employees.



Implementation & Evaluation Issues Regarding Missouri CHIPs and MC+ 



For many children and families the issue is not about being eligible for Medicaid, 

but about having the skills and inclination to access the system.  It is estimated 

that there are nearly 3 million Medicaid eligible children in the US that remain 

uninsured.  Often times the Īworking poorā (families not receiving aid who 

household incomes are < 300% of the poverty level) are those whose cultural 

norms and values leave them most resistant to the perception of public charity.   

It is for this reason that it is important when considering the implementation of 

the Missouri CHIPs through the expansion of MC+ that special attention be given 

to ensure that both the marketing and ultimately the services provided are 

delivered in a manner that is culturally sensitive and perceived as a citizensā 

benefit and not a public hand-out.



The following are examples of steps that may facilitate the enrollment of eligible 

children and adults:

¬ Simplify the application form including loosening requirements on 

documentation.

¬ Eliminate the assets test to determine eligibility for pregnant women 

and children.

¬ Allow applicants to submit their applications through mail, phone, or 

the internet.

¬ Allow community-based organizations to facilitate the outreach and 

enrollment process.

¬ Expand the use of MC+ ĪOutstationsā.  Currently the vast majority are 

in county government offices or hospitals.  They could be expanded on 

a permanent or revolving basis to schools, community centers, 

churches, grocery stories, or other outlets that the public frequents.



Implementation & Evaluation Issues of CHIPs and MC+ for LINC



LINC, specifically the Health Care Committee, has played an important advocacy 

role in shaping the expansion of MC+ for the Kansas City metro area.  The DSS 

Division of Medical Services expects LINC to take a leadership role in developing 

locally designed  marketing and education strategies.   Most of these strategies 

are further extension of LINCās diverse outreach efforts;



  Linking MC+ enrollment to the location and staff at the existing CNS sites can 

be easily managed. 

  LINC can also Īrecruitā other appropriate neighborhood based providers for 

participation in the marketing and enrollment process.

  CNS SNACs can provide valuable insights into marketing and educational 

strategies that will reach populations in need.  

  LINC will  continue to make MC+ provider information available on-line, thus 

allowing individuals to make location decisions about their health care 

provider based on where they live or work.







Background - Contents of the Missouri Medicaid 1115 Waiver



The policy decision to pursue a waiver was made with the goal of coordinating 

the CHIPs with the MC+ program (currently under federal waiver 1915B that 

allows Missouri the flexibility to shape its Medicaid program to state and local 

needs).  The reasoning is that the MC+ is a successful program that has proven 

to be accessible and that encourages preventative care.  Thus, it makes more 

sense to coordinate and expand an existing program than to initiate a second 

(and in many ways parallel) program. 



The Missouri CHIPs based on the 1115 Waiver would extend coverage to the 

following populations:

¬ Uninsured children with net family income up to 200% of the federal 

poverty level or with gross family income up to 300% of the federal 

poverty level;

¬ Adults transitioning off of welfare with net family income up to 200% of 

the federal poverty line;

¬ Uninsured non-custodial parents with family income up to 125% of the 

federal poverty line who are current in paying their child support;

¬ Uninsured non-custodial parents with family income up to 100% of the 

federal poverty line who are actively participating in Missouriās Parentsā 

Fair Share program;

¬ Uninsured custodial parents with family income up to 100 percent of 

poverty; and

¬ Uninsured women losing their Medicaid eligibility 60 days after the 

birth of their child would be eligible for womenās health services, 

regardless of income level, for two years.



The Missouri CHIPs would enroll eligible clients through the following means;

¬ a combination of MC+ service centers and county DFS offices.  

Ž The MC+ service centers will recruit through a combination of 

mailings and telephone help lines.  

Ž DFS offices will be used to Īcatchā potential enrollees who are 

eligible but unenrolled when they visit the office for other 

reasons.



Background - Modifications to the Mo Medicaid 1115 Waiver by the 

Missouri Senate and Missouri House of Representatives as Passed on May 

15, 1998





Senate bill 632 (SB632) addresses the Missouri Medicaid 1115 Waiver.   The 

following information reflects all modifications to SB632 by the Missouri House of 

Representatives and was passed by both houses as of May 15, 1998.



¬ Defines coverage as available to children under age 19 from families with 

income under 300% of federal poverty guidelines who cannot afford private 

insurance.  For a family of four this includes available annual incomes up to 

$49,350.  

¬ CHIPs implements a $5 co-pay requirement for families between 186% and 

225% of the poverty level.  

¬ Co-payment requirements for families between 226% and 300% of the 

poverty level will be comparable to co-pays made by state of Missouri 

employees.

¬ CHIPs implements a premium of approximately $65 a month for families 

between 226% and 300% of the poverty level.  Doctor visits will require a $10 

co-pay and prescriptions will require a $5 co-pay.

¬ For families with incomes between 226% and 300% of the poverty level, a 

child must have been without access to employer subsidized health care 

insurance for six months prior to eligibility.

¬ Unaffordable insurance is defined as having a monthly premium more than or 

equal to 133% of the monthly average premium in the stateās current Missouri 

consolidated health care plan.  CHIPs co-pays and premiums are to be within 

one dollar of the average co-pay and premium of the stateās current Missouri 

consolidated health care plan up to 5% of a familyās annual income. 

¬ Enrolled children must participate in a wellness program unless the 

requirement is objectionable because of religious reasons or medical 

contraindication.

¬ Funds are prohibited from being used to Īencourage, counsel, or refer for 

abortion servicesā unless medically necessary to save the motherās life or in 

case of rape or incest.

¬ Requires parents/guardians of eligible children to demonstrate annually that 

their net worth does not exceed $250,000.

¬ DSS will commission a study one year after the CHIPs implementation to 

assess whether or not CHIPs is having a negative impact on private health 

insurance coverage.





 Background - Facts about Childrenās Access to Health Insurance



Based on 1994-95 data (adjusted to 1998) approximately 10.6 million children 

under age 18 are uninsured.  Of those, approximately 4.5 million are eligible for 

Medicaid, leaving 6.1 million children in the gap between eligibility for Medicaid 

benefits and the ability of their families to provide private health insurance.



Approximately 7.5 million of these children live in families at 200% of the federal 

poverty line or below.



In Missouri, it is estimated that there are 90,000 uninsured children most of 

whom do not qualify for Medicaid benefits.  The following table estimates the 

number of currently uninsured children that would be eligible for participating in 

the Missouri CHIPs:



Kansas City, Missouri Metro Region 









	Total All	Children	Children 	Children	Children

	Waiver 		up to 200% 	201-250%	251-300%	> 300%

	Children 	Poverty		Poverty		Poverty		Poverty

Jackson 9,449		5,303		2,707		902		537

Cass	645		384		196		65		0

Clay	954		567		290		97		0

Platte	251		149		76		25		0

Total	11,299		6,403		3,269		1,089		537







Background - Facts about Adults with Childrenās Access to Health 

Insurance



It is estimated  that in the United States in 1997 there were 52 million uninsured 

adults age 18-64.  Of those 52 million uninsured adults, 8 of 10 are members of 

working families and 8 of 10 have family incomes above the poverty level.  



Of these 8 families 32% are low income families (< 200% of federal poverty 

level) and another 31% are middle income families (200% - 400% federal 

poverty level).



In Missouri it is estimated that the CHIPs program through delivery as an 

expansion of the MC+ program can extend coverage to between 60,000 and 

80,000 currently uninsured adults. 



The following table estimates the number of currently uninsured adults that 

would be eligible for participating in the Missouri CHIPs:



Kansas City, Missouri Metro Region 











	Total All	Adults  	TANF Adults 100-300% Poverty

	Working 	< 100%

	Parents		Poverty

Jackson 7,980		7,341		639

Cass	577		531		46

Clay	854		786		68

Platte	225		207		18	

Total	9,636		8,865		771









  Source: DSS Division of Medical Services.  Total estimate of uninsured based on 1996 Current 

Population Survey.  County distribution of uninsured based on current Medicaid for Children 

distribution.

  Source: Kaiser/Commonweatlh 1997 National Survey of Health Insurance

  Source: DSS Division of Medical Services.  Total estimate of uninsured based on 1996 Current 

Population Survey.  County distribution of uninsured based on current Medicaid for Children 

distribution.





 

Produced by the LOCAL INVESTMENT COMMISSION (LINC) 6/16/98

For more information contact Tracy Dranginis at (816) 889-5050 or visit the LINC web site at www.kclinc.org