SCHIP Benefits Structure
Title XXI allows States to expand coverage for children primarily through one of three
ways: a separate child health insurance program, the Medicaid program, or through a
combination of these programs.
States choosing to expand their Medicaid program must follow Medicaid requirements
regarding benefit structure. Section 1115 waivers, however, will allow States to modify
the Medicaid requirements within expansion programs. States implementing a separate State
program have five benefit package options from which to choose their plan. States may:
- Adopt one of three "benchmark" plans as minimum coverage standards:
- Standard Blue Cross/Blue Shield Preferred Provider option offered to Federal employees.
- The State’s employee health benefit plan.
- The Health Maintenance Organization (HMO) plan that has the largest share of commercial
non-Medicaid insured members in the State.
- Create a new benefit package that is actuarially equivalent to any one of the benchmark
packages, as long as the new package includes four basic categories of services:
- Inpatient and outpatient hospital services.
- Physicians’ surgical and medical services.
- Laboratory and X-ray services.
- Well-baby and well-child care, including appropriate immunizations.
- Apply to the Secretary of the Department of Health and Human Services (HHS) for approval
of another benefit package.
Related Questions
Give me an overall
context
Give me more details
Give me an example
Take to me related sites
- HCFA. (now CMS) Section 2103: Coverage Requirements
for Child Health Insurance. This letter, and other HCFA (now CMS) guidance can be found at http://www.cms.hhs.gov/home/schip.asp
 . In the Title XXI Summary of the Balanced Budget Act of
1997. August 5, 1997.
What else does this lead to?
Where else is HCFA (now CMS) guidance discussed?
Who presented this
material?
|
Benefit Design 
