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

For States implementing separate, non-Medicaid expansion programs, the Health Care Financing Administration (HCFA), now the Centers for Medicare and Medicaid Services (CMS), outlined rules regarding cost-sharing in SCHIP. Again, refer to the 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 State SCHIP plan must include a description of the amount of all cost-sharing charges imposed under SCHIP and any such charges must be imposed according to a public schedule.

• Enrollment fees, premiums, or other similar charges on children with family income at or below 150 percent of Federal Poverty Level (FPL) must not exceed maximum amounts that may be imposed under Medicaid.

• Premiums must be based on an income-related sliding scale, and be limited to no more than a specified monthly amount per family.

• Copayments, deductibles, or similar charges for children below 150 percent of poverty must be nominal and consistent with Medicaid regulations.

• No copayments are permitted on preventive services including but not limited to well-child care, well-baby care, and immunizations.

• Total cost-sharing for families above 150 percent of poverty must not exceed 5 percent of income, and a mechanism to ensure families do not exceed this limit must be described in the State plan.

Related Questions

Give me an overall context

• Overview of Cost-Sharing

Give me an example

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

• Results of the Study "The Use of Sliding Scale Premiums in Subsidized Insurance Programs"

• New York State's Child Health Plus Program

• Details of the Florida Healthy Kids Corporation's Experience

Show me some lessons learned

• Implications of Past State Experiences for Effect of Cost-Sharing on SCHIP Access and Utilization

<What other issues are talked about in this section?

• Title XXI Cost-Sharing Regulations for 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.