All states are currently revising their insurance regulations to come into compliance with the 2010 Patient Protection and Affordable Care Act, which, in accomplishing health care reform in the United States has also dramatically altered the national insurance landscape. A major change that has already taken effect is the prohibition against excluding children from health coverage based on the presence of a pre-existing condition. (This same protection will also be extended to adults in 2014.) Additionally, children may also remain on their parents’ health coverage up to age 26. It does not matter if the child is a student or has married.
The states are also working with the federal government to put temporary high risk insurance pools in place for people with pre-existing conditions. These pools will function until January 1, 2014 when the health care exchanges required under the Affordable Care Act go into effect.
General Insurance Regulations
Insurers in Missouri are not currently allowed to permanently exclude coverage for a pre-existing condition, but they may impose a two-year waiting period. Policies must, however, have a clause of guaranteed renewability so long as the premiums are being paid and all the terms of the contract are being met.
For small companies to offer group insurance plans, they must have 2 to 50 employees. In group plans, the coverage is guaranteed issue and the look-back period is limited to 12 months.
Creation of Health Care Exchange
Missouri is continuing to study its options to establish a health care exchange, but in August 2010, Governor Jay Nix allowed a bill to become law without his signature. The statute prohibits any exchange established in the state from offering policies that provide coverage for abortions unless the mother’s life is in danger.
Pre-Existing Condition Insurance
Residents of Missouri who are eligible can apply for insurance through the state’s Pre-Existing Condition Insurance Plan, which is administered by the Missouri Health Insurance Pool. The coverage includes benefits for both primary and specialty medical care as well as hospital stays and prescription drugs. Premiums range from $150 to $548 a month, with deductibles of $1000 to $5000.
Medicaid eligibility is figured according to set percentages of the Federal Poverty Level. In Missouri, infants under the age of one qualify for Medicare at 185% FPL, with those in the age 1-5 bracket gaining eligibility at 133%. This age group also qualifies for the children’s Medicaid expansion program, CHIP, at 133% FPL. Children age 6-19 qualify at 100% and 150% for the two programs respectively.
Pregnant women can claim Medicaid benefits at 185% FPL, and the aged or permanently disabled at 85%.
Missouri HealthNet coverage is provided for children who do not qualify for Medicaid, but who cannot get coverage via other avenues. It also provides aid to Medicare recipients in meeting their out-of-pocket expenses, along with a state-funded prescription program called MORx.
Approximately 16 percent of residents in the state draw Medicare benefits, with more than 969,000 residents accessing prescription drug coverage.
The state health insurance program, called CLAIMMissouri, offers counseling services about both Medicare and Medicaid assistance options.
The major source of welfare in Missouri is the federally funded Aid to Dependent Families or AFDC program. Approximately 91,000 families in the state draw cash payments through the program. Eligibility is also figured via income and some recipients transition from Medicaid to AFCD, so it is also a source of potential funding to low-income families for health care.