208.178. Health insurance coverage through Medicaid, eligibility--rules.
Health insurance coverage through Medicaid, eligibility--rules.
208.178. 1. On or after July 1, 1995, the department of social servicesmay make available for purchase a policy of health insurance coverage throughthe Medicaid program. Premiums for such a policy shall be charged based uponactuarially sound principles to pay the full cost of insuring persons underthe provisions of this section. The full cost shall include bothadministrative costs and payments for services. Coverage under a policy orpolicies made available for purchase by the department of social servicesshall include coverage of all or some of the services listed in section208.152, RSMo, as determined by the director of the department of socialservices. Such a policy may be sold to a person who is otherwise uninsuredand who is:
(1) A surviving spouse eligible for coverage under sections 376.891 to376.894, RSMo, who is determined under rules and regulations of the departmentof social services to be unable to afford continuation of coverage under thatsection;
(2) An adult over twenty-one years of age who is not pregnant and whoresides in a household with an income which does not exceed one hundredeighty-five percent of the federal poverty level for the applicable familysize. Net taxable income shall be used to determine that portion of income ofa self-employed person; or
(3) A dependent of an insured person who resides in a household with anincome which does not exceed one hundred eighty-five percent of the federalpoverty level for the applicable family size.
2. Any policy of health insurance sold pursuant to the provisions ofthis section shall conform to requirements governing group health insuranceunder chapters 375, 376, and 379, RSMo.
3. The department of social services shall establish policies governingthe issuance of health insurance policies pursuant to the provisions of thissection by rules and regulations developed in consultation with the departmentof insurance, financial institutions and professional registration.
(L. 1993 H.B. 564 § 15)