On Tuesday, Oct. 20, 2026, Children's Mercy announced it will not be included in Affordable Care Act (ACA) Marketplace insurance networks beginning Jan. 1, 2027. DCI recognizes the deep concern and uncertainty this development causes for Missouri families who depend on specialized pediatric care for their children. Our immediate priority is ensuring Missouri families understand their rights and how to navigate care transitions.
DCI is not aware of any pending contractual termination or dispute, and no Missouri health plans have recently dropped or are planning to drop Children’s Mercy from their 2027 networks. Rather, Children’s Mercy has operated on an out-of-network status with most Missouri individual health plans for a number of years. For most Missourians who get their health coverage through their employer, please know the DCI is not aware of any changes to networks or access to Children’s Mercy Hospital in 2027.
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.
What can you do?
- Verify Your 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. Visit DCI’s out-of-network care page for more information about what this means for you and your family.
- Explore Continuity of Care Protections: If a child is actively receiving treatment for a serious and complex condition, 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.
- 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 – and they should reconfirm the network status periodically and certainly before any major medical services or procedures like surgery. To see which carriers are offering coverage in the individual market in your county, visit DCI’s online health insurance market map.
- Contact DCI Consumer Assistance: Missouri consumers with questions about their rights, insurance policies or dispute processes can contact the DCI Insurance Consumer Hotline at 800-726-7390 or visit DCI’s health insurance page for more information and resources.
What is DCI’s authority?
Not all health plans fall under DCI’s jurisdiction. DCI has jurisdiction over “fully insured” health plans. Missouri law does not grant DCI statutory authority to review, approve, or enforce network adequacy standards for individual health plans sold on the ACA Marketplace.
What is network adequacy?
Network adequacy refers to a health plan's ability to deliver the benefits promised by providing reasonable access to enough in-network primary care and specialty physicians, and all health care services included under the terms of the contract.
The ACA requires that health plans participating in qualified health plans (QHPs) in the marketplaces (also known as "exchanges") meet network adequacy standards. These include ensuring consumers have access to needed care without unreasonable delay.
Missouri’s network adequacy laws apply only to health maintenance organizations (HMOs).
What are Essential Community Providers (ECPs)?
ECPs are providers that historically serve medically needy or medically indigent patients and demonstrate a commitment to serving low-income and medically indigent populations who comprise a significant portion of the patient population.
My health plan doesn’t have my provider in network. Can I file a complaint?
Yes. Keep in mind the DCI only has regulatory authority over fully insured health plans. Fully insured plans only cover about 25% of Missourians. It is very likely if you get your coverage through your employer, your plan is not fully insured.
You can file a complaint online or call our toll-free Insurance Consumer Hotline at 800-726-7390.
If you are covered by a health plan is not fully insured or under the DCI’s regulatory authority, we have information to help you. This reference page provides contact information for plans not regulated by DCI, so you know who to contact when you need assistance.