SMHB provides Children's Health Insurance Program (CHIP) and Presumptive Eligibility (see Presumptive Eligibility manual section 1900.000.00) coverage to low income unborn children.
This coverage is extended to the mother of the unborn child without requiring payment of a premium.
Senate Bill 716 (2014) added section 208.662 to the Revised Statutes of Missouri (RSMo) establishing within the Department of Social Services the "Show-Me Healthy Babies Program" as a separate CHIP program for any low-income unborn child. The program is established under the authority of Title XXI of the Federal Social Security Act, the State Children's Health Insurance Program, as amended and 42 CFR 457.1.
The Show-Me Healthy Babies Program is not an entitlement program, but instead is subject to a federal allotment, or other federal appropriations and matching state appropriations.
Eligibility for this program cannot be determined until a MO HealthNet for Pregnant Women application has been submitted, processed, and denied for excessive income or citizenship.
NOTE: If a pregnant woman is denied for MPW due to failure to cooperate she is not eligible to be screened for SMHB.
Eligibility guidelines for the Show-Me Healthy Babies program are:
NOTE: A Social Security number is not a factor of eligibility for the pregnant mother or other household members. While obtaining a social security number is not a factor of eligibility, the social security number should be requested as it may be necessary to verify income.
NOTE: Citizenship is based on the unborn child. Since the child will be born in Missouri they will be a United States citizen. Household composition is determined based on the child.
The participant 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 Family Support Division (FSD) may request more verification if information is not reasonably compatible with the participant's attestation.
NOTE: If an application is submitted the same day a child is born or after, the child and mother are not eligible for SMHB as there is no longer an unborn child in the household.
This requirement is the same as for all Modified Adjusted Gross Income (MAGI) programs. Refer to manual section 1805.005.00.
Income eligibility for SMHB will be determined using MAGI Methodology and comparing the MAGI to the appropriate percentage of Federal Poverty Level (FPL). When calculating the household composition, use the tax-filing status of the mother.
An unborn child is eligible for SMHB healthcare coverage if the household's MAGI income meets one of the following criteria:
The mother of an unborn child enrolled in the Show-Me Healthy Babies (SMHB) program must be uninsured. Uninsured individuals are defined as persons who do not have health insurance and for SMHB, do not have insurance that covers pregnancy related services. A person covered by health insurance at the time of a SMHB eligibility determination is ineligible, unless:
In addition to being uninsured, the woman cannot have access to employer-sponsored health insurance (either through her employer or her spouse's) that provides pre-natal care / maternity benefits. Having insurance or accessibility to insurance that includes pre-natal care / maternity benefits can be verified through self-attestation.
FSD staff processing the application must use the Affordability Calculator to determine if affordable insurance is available to this family. DO NOT require the family to provide insurance quotes unless they disagree with the Calculator determination. If the family disagrees, they made give quotes verbally or in writing at an FSD office or through the FSD Information center at 1-855-FSD-INFO (1-855-373-4636).
If affordable employer sponsored insurance is not available, evaluate access to affordable private insurance coverage. FSD must refer to the Affordability Calculator to determine if affordable insurance is available.
If the Affordability Calculator determines that affordable insurance is available and the family disagrees with this decision, they may provide quotes verbally or in writing on the cost of health insurance for the mother and unborn child which include maternity services from two private insurance companies.
Applicants may submit this information in one of the following ways:
NOTE: Written verification from the insurance companies is not required, but the applicant must supply names of the insurance companies.
NOTE: Undocumented immigrants do not have access to affordable insurance, as they cannot purchase an insurance plan through the Federally-facilitated Market Place at www.Healthcare.gov.
A private insurance policy causes ineligibility if it:
If the private insurance quotes are above the affordable amount, the family does NOT have access to affordable insurance and the pregnant woman and unborn child are eligible on that factor. If one or both of the private insurance quotes are less than the affordable amount the family has access to affordable insurance and the pregnant woman and unborn child are not eligible for SMHB coverage.
An unborn child is ineligible for the Show-Me Healthy Babies Program if his/her mother is eligible for any other MO HealthNet program that provides full benefits and does not require a premium or a spend down in exchange for coverage.
NOTE: Explore eligibility for any MO HealthNet program that does not require a premium or spend down prior to exploring eligibility for SMHB.
EXCEPTION: If the pregnant woman is receiving Uninsured Women's Health Services (UWHS), Extended Women's Health Services (EWHS), premium CHIP coverage, Gateway To Better Health (GTBH), or MO HealthNet for Aged, Blind, and Disabled (MHABD) Spend Down program she may still be eligible for SMHB. When this occurs, approve SMHB before closing the existing coverage.
SMHB applications have the same timeframe as MPW applications. They must be completed within 15 days.
Coverage for an unborn child enrolled in the Show-Me Healthy Babies Program includes all prenatal care and pregnancy related services for the mother which benefit the health of the unborn child, and promote healthy labor, delivery, and birth. SMHB cases will be identified on MXIX with the following Medical Eligibility (ME) Codes:
NOTE: Women approved previous to post-partum period under ME 96 receive one post-partum visit.
There is no waiting period before an unborn child may be enrolled in the Show-Me Healthy Babies Program. If eligible, coverage begins with the date of application.
EXAMPLE: Mary is pregnant and applied for MO HealthNet for Pregnant Women (MPW) on 11/5/20xx. Mary is a US Citizen and her income is over the income guideline for MPW. She is denied for MPW and screened for SMHB. Her income is at or below 300% of FPL and she is eligible for SMHB. Her begin date for coverage is the day she applied: 11/5/20xx.
Senate Bill 716 (2014) ensures that children born to mothers approved for SMHB receive no-cost health coverage with no waiting period for their first year of life.
NOTE: Families may receive an invoice for $0 premium, but should disregard it.
Children of SMHB recipients who were denied MPW due to excess income only (income was above 196% of FPL, and mother is citizen or eligible alien) will be entered as a Show-Me Healthy Babies Newborn (SMHB-NB) with ME code 97.
Children of SMHB recipients who were denied MPW due to citizenship will receive the appropriate level of care for their reported household income. Upon report of the child's birth, ES should enter the household's income at time of the SMHB approval in the MAGI Calculator to determine the appropriate level of care (ME 62, 73, 74, or 75) for the child. Coverage will be entered using the ME code, a Federal Grant Indicator (FGI) of 8 (This will show as a "C" on MXIX), and a $0 premium, if appropriate.
EXAMPLE: Jane applied for coverage for her pregnancy on January 10, 20xx. Jane is not a US citizen or eligible alien. She was denied for MPW and approved for SMHB. Jane's child was born February 19, 20xx. Current records show that household income is 190% of FPL. The Eligibility Specialist determines the child would receive coverage for Child Under 1 (ME 62) The FGI of 8 (shown as a C in the TOC field on MXIX) indicates the child is SMHB until age one. Before the child's first birthday the household will be re-evaluated and the childmoved to the appropriate level of care.
An ex parte review must be completed before the child turns age one (1).
SMHB mothers will receive coverage for labor and delivery.
Postpartum coverage for mothers who were denied for MPW due to excessive income only and eligible for SMHB will begin on the day the pregnancy ends, and extend through the last day of the month that includes the sixtieth day after the pregnancy ends. An ex parte review must be completed at the conclusion of the post-partum period.
For all mothers who were denied MPW due to citizenship, post-partum coverage will be limited and SMHB will end with the day following discharge from the hospital after the birth of their child.
Participants in the SMHB program are not eligible for automatic Extended Women's Health Services (EWHS). They would need to meet eligibility guidelines for Uninsured Women's Healthcare Services (UWHS) to receive family planning services. See Income Maintenance Manual section 1870.000.00 Uninsured Women's Health Services Program for more information .