Page 4

4 • On March 17, 2009, Idaho submitted a CHIP SPA, which proposes to add coverage for substance abuse services, reduce limits for partial care, psychosocial rehab, therapy services and developmental disability agency services.

Children Covered Under Program

The State reported that 43,526 children ever enrolled in CHIP during FFY 2008.

Administration

The program is administered by the State Medicaid Agency.

Health Care Delivery System

• The State utilizes its current Medicaid delivery system to provide services to CHIP enrollees. The delivery system is a primary care case management model.

Benefit Package

• CHIP enrollees will receive one of two benefit packages based on health care needs. Most children will be covered under the Basic Benchmark Benefit Package. Children with special health needs will be enrolled in the Enhanced Benchmark Benefit Package.

• These benefit packages are Secretary-approved coverage. The benefit package includes well-baby and well-child services, immunizations, emergency services, inpatient and outpatient care, prescription drugs, diagnostic services, vision services, and inpatient and outpatient mental health services.

Cost Sharing

Premiums are imposed for children with family income above 133 percent of the FPL. Enrollees in the Basic Benchmark Benefit Package with family incomes above 133 percent of the FPL to 150 percent FPL will be subject to a premium in the amount of $10 per member per month for medical services and are not subject to a dental premium. Enrollees in the ‘Basic Benchmark Benefit Package’ with family incomes from 150 percent up to and including 185 percent of the FPL will be subject to a premium in the amount of $10 per member per month for medical services and an additional $5 per member per month for dental services. Enrollees in the Enhanced Benchmark Benefit Package are not subject to premiums. Enrollees have a nominal co-payment of $3 for participants who seek care at a hospital emergency department or access emergency transportation for a non emergency condition.

Coordination Between CHIP and Medicaid Idaho uses a single application, and children are first evaluated for regular Medicaid. Those who are found eligible for regular Medicaid are enrolled in Medicaid. A child who