Missouri Department of Commerce and Insurance clarifies Children's Mercy network status following public statement

JEFFERSON CITY, Mo. – Following recent news and social media reports, the Missouri Department of Commerce and Insurance (DCI) wants to reassure Missouri families who receive care from Children’s Mercy Hospital in Kansas City. DCI is not aware of any health insurance carriers planning to remove Children’s Mercy from their provider networks in 2027, after concerns raised by the hospital's recent public statement. Children’s Mercy did not contact or notify the department of its network concerns prior to issuing its statement.

“At this point in time, our immediate priority and concern is ensuring Missouri families understand what is occurring, the facts and the law, their rights as consumers, and how to navigate care transitions where necessary,” DCI Director Angela Nelson said. “As a native Kansas Citian, I know the importance of Children’s Mercy to not only the Kansas City community but areas across the state.”  

Based on what the department learned today, there is no pending contractual termination or dispute, and no Missouri health plan has recently dropped or announced plans to drop Children’s Mercy from its 2027 networks.

Rather, Children’s Mercy has operated as an out-of-network provider for most individual health insurance plans in Missouri for a number of years. DCI believes the issue giving rise to Children’s Mercy’s recent statement involves the single insurer Children’s Mercy was in-network with in 2026. That insurer has announced its intention to leave the ACA Marketplace in the Kansas City metro.

DCI wants to stress that, based on the most current information it has received, it does not believe most Missourians who get their health coverage through their employer will experience any changes to their health plan’s network access. This issue is isolated to health plans sold in the individual market. 

Steps Missouri families can take to protect their access to care

DCI advises Missouri consumers who will be shopping for health coverage in the upcoming open enrollment period for coverage starting in January 2027 and who may be affected by the out-of-network status of Children’s Mercy to take the following steps:

1. Verify Network Status: Contact both your health insurance carrier and Children's Mercy (or your child’s health care provider) to determine whether your specific plan is impacted. If you are covered under a plan provided or paid for by your employer, another good resource is your company’s human resources or benefits department.
2. Explore Continuity of Care Protections: If a child is actively receiving treatment for a serious and complex condition, and their health plan will no longer have in-network access for Children’s Mercy in 2027, parents should immediately contact their insurer to request a continuity-of-care exception under federal law. Under certain circumstances, insurance plans may permit patients to continue receiving care from an out-of-network specialist at in-network benefit levels for a transitional period. Continuity of care must be arranged prior to the expiration of the network status change.
3. Review Coverage Options: Consumers shopping for coverage during open enrollment or navigating a special enrollment period should carefully verify hospital and physician network participation before selecting a plan. They should also reconfirm the network status periodically and certainly before any major medical services or procedures like surgery.
4. Contact DCI Consumer Assistance: Missouri consumers are never alone in navigating the complex health coverage process. Any Missouri consumer with questions about their rights, insurance coverage, or a dispute about their coverage can contact the DCI Insurance Consumer Hotline at 800-726-7390 or visit insurance.mo.gov for more information and resources.

“We recognize the deep concern and uncertainty this news and social media posts may cause for Missouri families who depend on specialized pediatric care for their children,” Director Nelson added. “I want to emphasize that CMHC and health insurers can come together and enter into a network agreement at any time. I am hopeful and will always do everything within my authority to ensure Missouri consumers have access to the coverage they need from the providers and facilities they choose.”

Understanding DCI’s regulatory authority

Under current Missouri law (Section 354.603 RSMo.), DCI does not have the legal authority to review, approve or enforce network adequacy standards for individual health insurance plans sold on the Affordable Care Act (ACA) Marketplace.

The only health plans DCI has legal authority to review network adequacy for are health maintenance organization (HMO) health plans. HMO plans currently insure fewer than 14,000 individuals statewide. None of the individual health plans offered on Missouri’s ACA Marketplace in 2026, or those scheduled to be offered in 2027, are HMOs. DCI also lacks the authority to review network adequacy for individual health plans sold outside the ACA Marketplace and any other non-HMO employer group health plans.

Because Missouri has not enacted network adequacy requirements for these plans, oversight and enforcement for qualified health plans sold on the ACA Marketplace are conducted by federal regulators, including the Centers for Medicare & Medicaid Services (CMS) and the Center for Consumer Information and Insurance Oversight (CCIIO) within the U.S. Department of Health and Human Services.

Expanding state-level network adequacy standards to include fully insured, non-HMO health plans, individual and group, would require legislative action. DCI stands ready to provide assistance and insurance market data to members of the Missouri General Assembly interested in exploring additional consumer protections.

“Missouri families should not have to navigate complicated insurance questions on their own,” Director Nelson said. “Our team is always here to help consumers understand their coverage, explore their options and connect with the resources available to them.”

DCI is charged with protecting Missouri consumers through oversight of the insurance industry, banks, credit unions, utilities and various professional licensees operating in the state. For more information about the department, please visit our website at dci.mo.gov.

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