[Poverty at Issue]
A Newsletter for Individuals Concerned About Poverty in Missouri

Fall 1999

In this issue:

Missouri Medical Programs, A Brief History

MC+ for Kids, Missouri's CHIP Program

New Medical Assistance Programs for Parents

Consumer Tips

Factors Influencing Health Insurance Coverage--Who's Not Covered? 

This Poverty At Issue is about medical assistance programs for Missouri families.  Between 1997 and 1998, the U.S. added about one million people to its ranks of the uninsured.  By 1998, some 44.3 million people in the U.S.--16.3% of the total population--were uninsured.  By contrast, Missouri's rate of uninsured people fell from 12.6% to 10.5% of its population in the same period.  In 1998, some 570,000 Missourians went without health insurance.

Recent expansions of medical assistance programs in Missouri have extended coverage to many previously uninsured families.  This Poverty At Issue provides a history of medical programs in Missouri, gives detailed information about the new MC+ for Kids program, highlights the new MC+ programs for both custodial and non-custodial parents, and presents a summary of  findings from a new report from the Department of Commerce which discusses factors related to being uninsured.  Consumer tips are also provided.

I hope you find this information helpful.

Brenda Procter
Consumer and Family Economics Specialist

A Brief History

Missouri Medical Programs

The Medicaid Program was authorized by Federal legislation in 1965. It was established to provide health care access to low-income persons who are age 65 or over, blind, disabled, or members of families with dependent children.

In October 1967, the Missouri General Assembly established a medical services program under Title XIX of the Social Security Act-the Missouri Medicaid Program. Since that time, legislation and mandates have expanded categories of eligibility to include Medicaid coverage for children and pregnant women in poverty, refugees, and children in State care.

The Missouri Medicaid program is jointly financed by the Federal government and Missouri State Government. It is administered by the Missouri Division of Medical Services, a division of the Department of Social Services.

Changes in Medicaid Since 1980
As the time line below documents, medical assistance for families has become increasingly complex since the inception of the original Medicaid Program in 1965.

This brief history pertains only to medical eligibility for members of families with dependent children. Prior to 1980, eligibility for coverage depended upon the family’s eligibility for Aid for Families with Dependent Children (AFDC). That is no longer true.

August 1980
Based on eligibility under then existing AFDC standards, the Pregnant Women Unborn Child medical assistance program was introduced to cover children not yet born to AFDC-eligible women.

October 1981
Provisions were added to standardize who was in the "filing unit" for a family applying for AFDC (and thus for Medicaid). Prior to that, families themselves decided who was in the filing unit.

July 1987
The Pregnant Women Unborn Child program expanded to remove a requirement that the filing unit be deprived of parental support to be eligible; coverage was added for a 60-day, post-partum period.

January 1988
The Pregnant Women Unborn Child program was again expanded to cover those with a family income up to100% of the Federal Poverty Level. Medicaid for Children was introduced, providing medical coverage to a group of age-limited children whose family income was less than 100% of the Federal Poverty Level.

December 1988
A court order in Lutz vs. Reagen changed standard filing unit provisions such that eligibility of one child for Supplemental Security Income (SSI) could not automatically disqualify the whole family for Medicaid eligibility.

April 1990
The Transitional Medicaid program began, providing medical benefits for up to one year for families who lost eligibility for assistance due to employment or employment-related factors.

July 1990
The Pregnant Women Unborn Child program expanded again, to include those with a family income up to 133% of the Federal Poverty Level, provide continuous Medicaid eligibility for pregnant women who lose eligibility for other assistance, and establish TEMP, a temporary Medicaid program for pregnant women.

January 1991
The Automatic Medicaid Eligibility for Newborn Children program began.

July 1991
The Medicaid for Children program expanded to provide coverage to children born after 9/30/83, ages 6 to 19, whose family income was less than 100% of the Federal Poverty Level. The TEMP program was expanded to lengthen the presumptive eligibility period.

January 1994
Medicaid for Children again expanded to allow coverage for children under age 1 at a family income up to 185% of the Federal Poverty Level. The "born after 9/30/83" provision was eliminated. The Medicaid for Pregnant Women program expanded to allow coverage at up to 185% of poverty as well.

April 1996
Medicaid for Children and Medicaid for Pregnant Women were changed to invoke a test of "financial responsibility" when determining mandatory members of the eligible assistance group.

August 1996
The Personal Responsibility and Work Opportunity Reconciliation Act eliminated AFDC, eligibility for which also determined eligibility for all pre-1980 medical assistance programs.

December 1997
The Medical Assistance for Families program began. It continues Medicaid coverage to anyone on Temporary Assistance (has replaced AFCD) who has reached their lifetime limit of 60 months. It covers all family members in the assistance group, is not time limited, and offers the most comprehensive health care coverage.

July 1998
An MC+ initiative began, which converted the Medicaid for Children and Medicaid for Pregnant Women programs to managed care coverage.

September 1998
The MC+ for Children program (Missouri’s implementation of the Federal Children’s Health Insurance Program-CHIP) began. It expanded coverage to include children who were not eligible for other insurance programs and with family incomes up to 300% of the Federal Poverty Level.

October 1998
Families Together, a cooperative program of Children’s Services and Income Maintenance Sections of DFS, began. The program lets families whose children have come into custody of DFS for a short period of time (30-60 days) continue qualifying for assistance if the service plan is to return the children to their home within Families Together time frames. Medical Assistance for Families eliminated a resource test and "deprivation of parental support" requirement.

February 1999
Several programs began: MC+ for Uninsured Custodial Parents, MC+ for Uninsured Non-Custodial Parents, MC+ for Parents’ Fair Share Participants, and Extended Women’s Health Services (begins at the end of the 60-day post-partum period). Transitional Medical Assistance expanded to allow coverage for up to 24 months for a caregiver relative.

April 1999
MC+ and Medical Assistance for Families programs changed to allow the inclusion of previously ineligible aliens in the assistance group.

Missouri’s CHIP Program

MC+ for Kids

MC+ for Kids is a health insurance program for uninsured Missouri children in low-income families who do not otherwise have access to affordable health insurance. It is Missouri’s version of the federally mandated Children’s Health Insurance Program (CHIP).

Approximately 90,000 uninsured Missouri children are eligible for MC+ for Kids. Over 50,000 children are enrolled statewide, which compares favorably with enrollment rates in many other states’ versions of CHIP.

MC+ for Kids is intended to expand the availability of health insurance for uninsured children; provide a primary care provider to coordinate children’s health care and preventive services; and increase the cost efficiency of health care services.

Who is Eligible for MC+ for Kids?

Uninsured children, ages birth to 19, whose gross family income is up to 300% of the Federal Poverty Level, may be eligible. They must have gone without insurance for at least six months. If a family loses insurance through no fault of their own, they may be eligible without waiting 6 months. A child or children in a family of three making less than $3,470 per month would be eligible for coverage if they met the "six month as uninsured" rule. The chart, "Do Your Children Qualify?" provides more detailed information.

Income Limits & Fees

Depending on family size and income, children in some families will be covered at no cost. Others will have to co-pay $5-$10 per visit. Some children will receive prescription drugs for free and others will make a $5 co-pay. Families in the higher range of qualifying incomes will be expected to also pay a $68 monthly premium for their children’s coverage.

Do Your Children Qualify?
What You Pay

Maximum Monthly Income Per Family Size
(includes parents and children)

2 3 4 5

$1,706 $2,140 $2,575 $3,010
$5 Visit & No-Cost Prescriptions
$2,074 $2,603 $3,132 $3,660
$68 Monthly
$10 Visit &
$5 Prescriptions
$2,765 $3,470 $4,175 $4,880

All families will pay no more that 5% of their annual income for premiums and co-payments in a year.  If out-of-pocket expenses reach the 5% limit, the family will not have to pay the premium and/or co-payment for the rest of the year.

A family who misses a premium payment will lose coverage and be required to wait six months before re-enrolling in MC+ for Kids.

If a family is deprived of parental support, the caretaker must assign medical support rights to the Division of Child Support Enforcement and cooperate with them in obtaining medical support.


MC+ for Kids Services

Children can receive all medically-necessary services from their plan, including:

Unlike the non-CHIP children’s medical assistance programs, MC+ for Kids under CHIP does not provide non-emergency medical transportation.


MC+ for Kids Providers

First Health administers Missouri’s MC+ for Kids program. Children in three areas of Missouri-Central, Western and Eastern-receive covered services through managed care health plans operating through First Health under contract with the State.

Children in thirty counties and the City of St. Louis are covered through a health plan system. The other eighty-four Missouri counties have fee-for-service coverage. Reimbursement rates for providers are set by the State of Missouri.

Services for all covered professional services are unavailable or scarce in some areas of the State. According to Greg Vadner, director of Missouri Division of Medical Services, finding providers is a challenge in certain professional specialties. "Dental is probably the worst," says Vadner. "Reimbursement rates do not always entice dentists to become providers."

In some areas, vision care also is difficult to find under MC+. In general, a wider range of services is available through the managed care health plans.

Vadner says MC+ access issues are no different from access issues for other fee-for-service programs. "Primary care providers are generally available in all areas of Missouri. Specialty providers can be harder to find," he says.


MC+ for Kids Health Plans

Phone numbers for the individual health plan providers are listed below by region. Contracts can change periodically. An up-to-date list of providers is available online at: http://dss.mo.gov/.

The Central Region includes the following counties: Boone, Callaway, Camden, Chariton, Cole, Cooper, Gasconade, Howard, Miller, Moniteau, Monroe, Montgomery, Morgan, Osage, Pettis, Randolph, and Saline. They have three plans available.

Care Partners

HealthCare USA

Missouri Care

If you have questions about enrollment in the Central Region, call First Health toll-free at 1-800-348-6627.

The Western Region includes the following counties: Platte, Clay, Ray, Jackson, Lafayette, Cass, Johnson, Henry and St. Clair. The Western Region has four plans from which to choose.

Blue Advantage Plus

Family Health Partners

First Guard

Health Net

If you have questions about enrollment, in the Western Region, call First Health toll-free at 1-888-275-5908.

The Eastern Region includes the following counties: Franklin, Jefferson, St. Charles, and St. Louis County and the City of St. Louis. They have four available providers.

Care Partners

Community Care Plus

HealthCare USA


If you have questions about enrollment in the Eastern Region, call First Health toll-free at 1-800-348-6627.

In all other areas of the State, call toll-free (1-800-392-2161) for a listing of approved, individual, fee-for-service providers. If you have general questions about enrollment or policies, call First Health at 1-800-348-6627.

According to Mary Honse, MC+ for Kids Outreach Coordinator for Missouri Department of Social Services (DSS), applications sent to one of seven phone centers or to any local DFS office will be processed within 30 days, but the average time is about half that. Regardless of when the application is actually processed, one becomes eligible effective the date the application is received unless they are in the premium-paying group.

Those paying premiums are covered once they make a payment, but they are subject to a 30-day waiting period after date of application.

Eligibility rules change periodically, so those who want copies of applications for clients can download a current application from the web for distribution. MC+ information can be found at: http://dss.mo.gov/. Honse encourages anyone who would like more information from DSS to contact her at mhonse@mail.state.mo.us or 573-751-3770.

New Medical Assistance Programs for Parents

February 1999 brought two important medical assistance programs for parents of dependent children. The MC+ for Uninsured Custodial Parents and MC+ for Uninsured Non-Custodial Parents programs were created.

Parents are enrolled in MC+ managed care where available or fee-for-service if managed care is not available. Providers and managed care arrangements are the same as in the programs for children.

Similar expanded coverage also has been provided for Parents’ Fair Share Participants and pregnant women. The County Division of Family Services office can provide detailed information about these programs.

MC+ for Uninsured Custodial Parents

In February 1999, medical assistance was extended to uninsured, custodial parents whose family income is below 100% of the Federal Poverty Level. An uninsured, custodial parent is defined as "a person who is a biological or adoptive parent of a child under 19 years old in the home."


To qualify for their own MC+ coverage, uninsured custodial parents must:

Limits and Fees

Uninsured custodial parents must pay $10 co-pays for provider visits and $5.50-$7 co-pays for prescriptions. Cost sharing is due at the time of the visit, or care can be denied.


The coverage package for custodial parents is more restrictive than the MC+ for Kids and other adult Medicaid packages. Coverage includes most of the services covered by other recipients, with these major differences:


MC+ for Uninsured Non-Custodial Parents

MC+ for Uninsured Non-Custodial Parents provides health care coverage to uninsured, non-custodial parents who are current in their child support payments. They must be making payments at or above their legally obligated amount and have income under 125% of the Federal Poverty Level.


The following criteria apply to uninsured, non-custodial parents. They must:

Consumer Tips

All Missourians have a right to apply for medical assistance, whether or not they are certain about their own eligibility. Eligibility is no longer tied to Temporary Assistance recipiency, nor is it predominately tied to age.

The complexity of medical assistance programs is challenging. Anyone who is denied coverage can request a hearing, and they have a right to be told the reasons for their ineligibility in writing.

Remember that a missed premium payment or failure to comply with requirements to cooperate with Division of Child Support Enforcement on medical support orders can void coverage for six months or more.

If you do not understand something your caseworker tells you, ask questions. You have a right to fully understand your rights and obligations before signing any piece of paper. It is always a good idea to request and keep a copy of everything you sign.

Factors Influencing Health Insurance Coverage

Who's Not Covered?

A report just issued by the U.S. Department of Commerce identifies factors that can place an individual at risk for lacking health insurance coverage.  It is based on data from 1998.

Key factors influencing the chances of not having health insurance coverage are:

Among the poor, adults aged 18 to 64 had much higher noncoverage rates than either children of the elderly.

Among the poor, Hispanics also had the highest noncoverage rates, with 44.0 percent of that population uninsured in 1998.

Among those who were poor in 1998, there were no differences across the education groups.

However, among the poor, workers were less likely to be insured than nonworkers.  About one-half of poor, full-time workers were uninsured in 1998 (47.5 percent).

Poor immigrants were even worse off--53.3 percent were without health insurance.



Missouri Department of Social Services.

Missouri Division of Medical Services.

U.S. Department of Commerce, Economics and Statistics Administration, U.S. Census Bureau.

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Jeanne Bintzer, HES Extension Site Administrator

Brenda Procter, Consumer and Family Economics Specialist, Content Provider