Page 28

Application for the State of Indiana Children’s Health Insurance Program Amendment #7

Effective Date:

28

Approval Date: Section 8 Cost Sharing and Payment (Section 2103(e))

Check here if the state elects to use funds provided under Title XXI only to provide expanded eligibility under the state’s Medicaid plan, and continue on to Section 9.

8.1. Is cost-sharing imposed on any of the children covered under the plan? (42CFR 457.505)

8.1.1.

YES 8.1.2.

NO, skip to question 8.8.

8.2. Describe the amount of cost-sharing, any sliding scale based on income, the group or groups of enrollees that may be subject to the charge and the service for which the charge is imposed or time period for the charge, as appropriate. (Section 2103(e) (1) (A)) (42CFR 457.505(a), 457.510(b) &(c), 457.515(a) &(c))

8.2.1. Premiums:

Sliding scale premiums (see chart below) will be imposed on families of children eligible for the Title XXI CHIP program. Cost-sharing for these families (with incomes above 150% of FPL), will not exceed five percent of the family’s yearly income. Individuals eligible under MCHIP (with incomes up to 150% of FPL) will continue to comply with cost-sharing limitations established under Medicaid. CHIP individuals pay premiums monthly.

If an applicant is determined to be eligible for CHIP (Hoosier Healthwise Package C), ICES issues a notice to the applicant informing him or her of the premium payment responsibility for enrollment, and holds the account in suspense. Information regarding the eligibility status and cost-sharing responsibilities is transferred to the premium-collection vendor. The premium-collection vendor issues a premium statement and provides detailed information regarding the cost-sharing requirements. If the premium is paid by the due date, the premium-collection vendor transfers this information to ICES and the applicant’s account is changed from suspended status to enroll. The applicant becomes retroactively eligible for CHIP coverage beginning the first day of the month the application was submitted to the DFR.

If the premium is not paid by the due date (the 12th day of the month following eligibility determination), the applicant’s ICES account will remain in suspense and a second premium notice will be sent. If the premium has not been paid by the last day of the month following eligibility determination, the applicant will be notified that the application has been denied.

In situations where a child is enrolled in the program, but the family later fails to make a payment by the due date, a 60-day grace period will be provided. If fees are not paid by the end of the 60- day grace period, the child will be disenrolled from the program. Families that have been disenrolled due to non-payment of premiums may re-apply for coverage immediately. After meeting eligibility requirements, including the payment of all delinquent and current premiums due, the disenrolled child (ren) may be re-enrolled in the program.