Title XXI Cost-Sharing Regulations for Medicaid Expansion Programs

In a February 1998 letter to State officials, (this letter and other HCFA (now CMS) guidance can be found at http://www.cms.hhs.gov/home/schip.asp ), the Health Care Financing Administration (HCFA), now the Centers for Medicare and Medicaid Services (CMS), set out basic rules regarding cost-sharing in SCHIP.

For States implementing Medicaid expansion programs, the following rules apply:

• Enrollment fees, premiums, or similar charges on children are permitted under certain circumstances.

• Deductibles, coinsurance, copayments, or similar charges are prohibited.

• State cost-sharing obligations imposed by Medicaid must be followed.

• Cost-sharing must be "nominal."

• Services may not be denied even if a cost-sharing charge cannot be paid.

Related Questions:

Give me an overall context

• Overview of Cost-Sharing

• What Are the Implications of Instituting Copayments and Premium Cost-Sharing?

Give me an example

• What Are the Effects of Copayments and Premium Cost-Sharing on Access and Utilization in State Expansion Programs?

What other issues are talked about in this section?

• Title XXI Cost-Sharing Regulations for Non-Medicaid Expansion Programs

Where else is HCFA (now CMS) Guidance discussed?

• SCHIP Guidance - HCFA (now CMS) Guidance

Who presented this material?

• Judith Arnold, Leighton Ku, Ph.D., M.P.H., and Rose M. Naff addressed the issue of cost-sharing at SCHIP seminar held in Sanibel Island, Florida, June 29-July 1, 1998.  At the SCHIP seminar held later in Portland, Oregon, September 14-16, 1998, Rose Naff again addressed this issue.