Describe SCHIP Benefits Structure

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Describe 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

What Are the Healthcare Needs of Low-Income Children?

Give me more details

What Are Some Issues with SCHIP Benefits Options?

Describe the Current State of Implementation of SCHIP Benefit Structures

Give me an example

State Benefits Packages - Rhode Island RIte Care Program

State Benefit Packages - Connecticut’s Husky Program

Special Needs Strategies Example - Michigan

Special Needs Strategies Example - Connecticut

Take to me related sites

HCFA. Section 2103: Coverage Requirements for Child Health Insurance. This letter, and other HCFA guidance can be found at http://cms.hhs.gov/schip/. In the Title XXI Summary of the Balanced Budget Act of 1997. August 5, 1997.

What else does this lead to?

How Is the Intervention Defined for Monitoring/Evaluation?

Where else is HCFA guidance discussed?

SCHIP Guidance - HCFA Guidance

Who presented this material?

This material was taken from the HCFA Web Site [http://www.hcfa.gov/]

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