How Cost-Sharing
Experiences Under SCHIP May Be Different
Cost-sharing experiences under SCHIP may be different, however, than those under past or
other Medicaid expansions because:
- People may be more willing to pay nominal fees to insure their children--past estimates
were based on adult coverage cost-sharing experiences.
- Changes in the application process have made enrollment easier in most States.
- Publicity surrounding SCHIP may generate more interest and awareness.
- The types of benefit packages offered under SCHIP may encourage different utilization
patterns.
- Cost-sharing regulations for separate State programs regarding participants above 150 percent
of the Federal Poverty Level (FPL) are more flexible than those of Medicaid expansions;
and
- SCHIP cost-sharing regulations interact closely with Medicaid rules for participants who
are below 150 percent of FPL.
All cost-sharing reduces participation to some extent; therefore, not
instituting any cost-sharing is the only way to fully maximize enrollment. Enrollment,
however, is not the only issue States will need to consider. Other issues to be
considered are: encouraging personal responsibility, not encouraging
families to drop private coverage, and reducing cost to government. Each State will need
to strike a balance between such competing concerns in order to meet their specific needs
and goals.
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