Page 42

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

Effective Date:

Approval Date: September 19, 2002 42 amounts and any differences based on income. (Section 2103(e)((1)(B)) (42CFR 457.505(b))

Potential enrollees are notified of cost sharing requirements during the enrollment process and through outreach efforts. The combined application and the Fact Sheet describe cost-sharing requirements. The application requires applicants to attest that they understand and will comply with the requirements. The KidCare brochure and Member Handbook both describe cost-sharing requirements, including the cumulative maximum. All of these documents are available in hard copy form and on the KidCare website, www.kidcareillinois.com.

8.4. The state assures that it has made the following findings with respect to the cost sharing in its plan: (Section 2103(e))

8.4.1.

Cost-sharing does not favor children from higher income families over lower income families. (Section 2103(e)(1)(B)) (42CFR 457.530) 8.4.2.

No cost-sharing applies to well-baby and well-child care, including age-appropriate immunizations. (Section 2103(e)(2)) (42CFR 457.520) 8.4.3

No additional cost-sharing applies to the costs of emergency medical services delivered outside the network. (Section 2103(e)(1)(A)) (42CFR 457.515(f))

8.5. Describe how the state will ensure that the annual aggregate cost-sharing for a family does not exceed 5 percent of such family’s income for the length of the child’s eligibility period in the State. Include a description of the procedures that do not primarily rely on a refund given by the state for overpayment by an enrollee: (Section 2103(e)(3)(B)) (42CFR 457.560(b) and 457.505(e))

With a maximum premium of thirty dollars per month, or $360 per year, and a copayment cap of $100 per year, the maximum cost sharing that can ever be imposed equals $460 per year. The $460 limit does not mathematically approach 5% of an eligible family’s income under KidCare. This can be illustrated by applying the maximum total cost sharing against the minimum income possible under KidCare Share.

The minimum annual income for a child qualifying under KidCare Share is $11,784 (2002 FPL for a family of one ($8860) multiplied by 133% ). The $460 maximum cost sharing represents 3.9% of the person’s income. This example is used only as an illustration, since no premiums would be imposed at this income level.

The State’s $100 annual cap on family copayments is tracked by each