Mo. Code Regs. tit. 13 § 40-7.060

Current through Register Vol. 49, No.12, June 17, 2024

Section 13 CSR 40-7.060 - Show-Me Healthy Babies Program

PURPOSE: This rule establishes the eligibility requirements for the Show-Me Healthy Babies Program, in accordance with section 208.662, RSMo.

(1) Scope. This rule describes the eligibility requirements and coverage for the Show-Me Healthy Babies Program.

(2) For purposes of this section, the following definitions shall apply:

(A) "Affordable insurance" or "affordable health care coverage" shall mean a health insurance plan (employer-sponsored or otherwise) that covers the pregnancy and that requires monthly premiums equal to the amounts described in section 208.640, RSMo and section 1397cc(e)(3)(B) of Title 42, United States Code;

(B) "Household" shall have the same definition that appears in 13 CSR 40-7.020;

(C) "Modified adjusted gross income (MAGI)" shall mean income calculated using the same financial methodologies used to determine modified adjusted gross income as defined in section 36B(d)(2)(B), Internal Revenue Code, pursuant to the rules and exceptions in 13 CSR 40-7.030;

(D) "Participant" shall mean any individual who has applied for, or is receiving, or has been denied, income maintenance benefits or services through an income maintenance program administered by the Family Support Division (hereinafter, "division"), including an unborn child;

(E) "Post-partum" shall mean healthcare coverage continues until the last day of the month containing the sixtieth day after the termination of pregnancy; and

(F) "Program" shall mean the Show-Me Healthy Babies program, unless described otherwise.

(3) To be eligible for the program, a participant-

(A) Must be the unborn child of a pregnant woman. The pregnancy is verified upon the mother's (or her representative's) attestation that she is pregnant. The division may request more verification if information is not reasonably compatible with the participant's attestation in accordance with section 457.380(e) of Title 42, Code of Federal Regulations; and

(B) Must not be eligible for any other non-Children's Health Insurance Program (CHIP), MO HealthNet program that covers the pregnancy and does not require a premium or a spend-down in exchange for coverage; and

(C) Must not have insurance that covers the same pregnancy-related services as this program; and

(D) If not insured, does not have access to affordable insurance that covers the same pregnancy-related services as this program; and

(E) Must be in a household with a modified adjusted gross income no greater than three hundred percent (300%) of the federal poverty level, subject to the rules and exceptions in 13 CSR 40-7.030 and the verification requirements in 13 CSR 40-7.040.

(4) Coverage.

(A) This program provides to unborn children and their mothers the same coverage afforded to pregnant women under section 1397ll(d)(1) of Title 42, United States Code. This coverage includes but is not limited to-

1. Coverage effective no earlier than the month of conception;

2. Post-partum coverage for the mother that continues through the end of the month, in which the sixtieth day after the pregnancy ended occurs, provided the mother applied for services in the program while pregnant with the child.

(B) Participants in this program are not eligible for automatic, extended women's health services pursuant to 13 CSR 70-4.090.

(C) Children born to participants covered under this program are eligible for continuing coverage for one (1) year after the birth, under the applicable CHIP level of care. During this period, no premium shall be applied, regardless of the level of care.

(D) There is no waiting period for participants to receive coverage once they are determined eligible for the program, regardless of the household's level of income.

13 CSR 40-7.060

Adopted by Missouri Register May 16, 2016/Volume 41, Number 10, effective 6/30/2016