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State Children’s Health Insurance Program

Phase 1 Effective Date: April 1, 1998

Revised: 1/26/98, 2/19/98, 3/3/98, 3/6/98 Phase 2 Effective Date: July 1, 1998

Revised: 8/20/98, 8/24/98, 10/1/99, 7/28/00, 1/31/01, 7/02/02, 7/22/02, 1/3/03, 2/13/04, 9/27/04, 11/15/04, 8/11/05, 10/1/06, 7/1/09, 7/1/10, 7/1/11, 7/1/12 120

SCHIP Budget Plan Template Fiscal Year – 2012 - 2013

Federal Fiscal Year Costs Enhanced FMAP rate 70.66 Benefit Costs

Insurance payments

Managed care

per month rate $ 169.44 @ 3,181,944 eligibles 539,148,591 Fee for Service 0

0 Total Benefit Costs 539,148,591 (Offsetting beneficiary cost sharing payments) 33,144,496 Net Benefit Costs 506,004,098

Administration Costs

Personnel

General administration 9,292,904 Contractors/Brokers (e.g., enrollment contractors) 25,616,113 Claims Processing

Outreach/marketing costs 1,200,000 Other (Full Service School Health Services)

16,537,477 Total Administration Costs 52,646,494 10% Administrative Cost Ceiling 56,222,678

Federal Share (multiplied by enh-FMAP rate) 357,542,496 State Share 148,461,602 TOTAL PROGRAM COSTS 506,004,098

Note: The Federal Fiscal Year (FFY) runs from October 1st through September 30th. Note: Source of state share are:

General Revenue: $ 53,465,191 Tobacco Funds: $ 94,996,411