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Model Application Template for the State Children’s Health Insurance Program

Effective Date:

October 1, 2009 58 Approval Date: November 19, 2010 9.10. Provide a one year projected budget. A suggested financial form for the budget is attached. The budget must describe: (Section 2107(d)) (42CFR 457.140  Planned use of funds, including -- - Projected amount to be spent on health services; - Projected amount to be spent on administrative costs, such as outreach, child health initiatives, and evaluation; and - Assumptions on which the budget is based, including cost per child and expected enrollment.  Projected sources of non-Federal plan expenditures, including any requirements for cost-sharing by enrollees. CHIP Budget Plan FY2010

Enhanced FMAP rate 77.61 Federal Fiscal Year Costs Non-Federal plan expenditures Benefit Costs

Insurance payments

Managed care

Per member/per month $125 @ 711,807 member months of eligibles (end of FY 03 60,000 current enrollment)*

Fee for Service $ 172,241,610 Total Benefit Costs $ 172,241,610 (Offsetting beneficiary cost sharing payments) $ (4,346,339) Net Benefit Costs $ 167,895,271

Administration Costs

Personnel 5,010,689 General administration 2,676,420 Contractors/Brokers (e.g., enrollment contractors) 0 Claims Processing 0 Outreach/marketing costs 1,625,425 Other 687,466 Total Administration Costs 10,000,000 10% Administrative Cost Ceiling 18,655,030 Federal Share (multiplied by enh-FMAP rate) 138,064,520 State Share 39,830,751 TOTAL PROGRAM COSTS 177,895,271 State funding comes from three sources: State General Fund appropriations, Tobacco Settlement funds, and a private grant. A Robert Wood Johnson Foundation (RWJF) grant was awarded to Alabama to increase enrollment and retention of eligible children in Alabama’s health insurance programs, known as ALL Kids and SOBRA Medicaid (the Alabama Medicaid program for pregnant women and children). The grant is for $994,883 and the award dates are February 15, 2009 - February 14, 2013.