For States implementing separate,
non-Medicaid expansion programs, the Health Care Financing Administration
(HCFA) outlined rules regarding cost-sharing in SCHIP. Again, refer
to the February 1998 letter to State officials. This letter and other HCFA
guidance can be found at http://cms.hhs.gov/schip/
.
- 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
Give me
an example
Show me
some lessons learned
What other
issues are talked about in this section?
Where else is HCFA
Guidance discussed?
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.
[Top of Page]