HB 2513 -- Health Insurance for Children

Sponsor:  Baker (25)

This bill establishes the Covering All KIDS Health Insurance
Program within the Department of Social Services to provide
health insurance coverage for all uninsured children in the
state.  An eligible child will remain in the program for 12
months, but must reside in Missouri and cannot be older than 18
years of age.  Eligible children will be subject to monthly
premiums, co-payments, co-insurance, and deductibles.  Untimely
premium payments will result in loss of health insurance coverage
for the child, and the child cannot attempt to re-enroll in the
program for three months.  A child who is an inmate in a public
institution or mental health facility is not eligible for the
program.  The department will establish rules and procedures to
administer the program that include allowing application agents
to assist children in enrolling in the program for a technical
assistance fee and providing grants to application agents or
community-based organizations to educate the public about the
program, subject to performance standards and outcome measures.
The department must ensure adequate access to specialty
physicians and allow a primary care provider to make the
appropriate referrals to health care providers for children who
require care from a specialist.  Primary care providers will be
responsible for coordinating the care of the child who receives a
referral for a specialist.

The department must monitor the availability and retention of
employer-sponsored dependent health insurance coverage and modify
the time period eligibility requirements for the program if
necessary to promote retention of private or employer-sponsored
health insurance and timely access to health care services.
However, eligibility requirements cannot be set at less than six
months for the time period that a child has had no insurance
coverage.  The department must purchase and provide health care
benefits for the eligible children that are identical to the
benefits provided for children who are covered by the Missouri
Children's Health Insurance Program (CHIP), except for
non-emergency transportation.  The department can offer
alternatives to full enrollment to families and children such as:

(1)  Offering subsidies for families to help pay for the cost of
their private or employer-sponsored health insurance if the
subsidy is more cost-effective than providing coverage in the
program;

(2)  Offering partial coverage to children who have a
high-deductible private health insurance plan; and

(3)  Offering a limited benefits package to children of families
who have a private or employer-sponsored health benefit plan that
does not cover vision or dental benefits.

The department must conduct a study that includes estimating the
number of children with and without health insurance coverage and
the number of children who are eligible for and the number
enrolled in health insurance benefits through MO HealthNet, CHIP,
or employer-sponsored dependent coverage.  The study must also
include surveying the reasons why some families opt not to enroll
in employer-sponsored coverage and determining the
comprehensiveness of the dependent coverage available and
employee cost-sharing for the coverage.  The study will measure
health outcomes or other benefits of the children enrolled in the
program and analyze the effects of the utilization of health care
services for children.  Preliminary study results must be
presented to the Governor and General Assembly by July 1, 2010,
and final results by July 1, 2012.

Beginning in 2009, the department must annually report to the
General Assembly by September 1 for counties with a population of
100,000 or more, the number of:

(1)  Professionals serving in the primary care case management
program;

(2)  Non-primary care providers accepting referrals; and

(3)  Individuals enrolled in the program.

Disease management programs implemented by the department must be
developed using standards and guidelines set by relevant state,
national, and specialty medical organizations.  Performance
measures must be based on evidence-based scientifically sound
principles.

The department must request any necessary state plan amendments
or federal waivers needed to receive federal funds for
implementing the program.

Missouri House of Representatives
94th General Assembly, 2nd Regular Session
Last Updated October 15, 2008 at 3:12 pm