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

Effective Date:

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Approval Date:  Notice in the first premium voucher which is sent to the family by the premium collection vendor;  Notice in the members’ handbooks which are sent once the first premium has been paid and the child has been enrolled;  Public hearings are held regarding state statute rule changes including those defining cost sharing requirements;  Publication in the Indiana Register; and  Publication in the Indiana Administrative Code.  Enrollees are sent a notice generated from the eligibility system that informs them of their cost-sharing maximum

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))

Indiana will utilize a ―shoe box‖ approach, similar to that used by the Massachusetts CHIP program.

In an enrollment notice, automatically generated from the eligibility system, families are informed of their cost sharing limit based on their individual income, and instructed to keep records of their payments. They are further instructed to contact the Hoosier Healthwise Package C payment line for instructions about future payments if they believe their premium plus co-payments (if applicable) have reached the amount on the enrollment notice.

To ensure that no eligible children are charged cost sharing in excess of the cumulative cost- sharing maximum the office will obtain monthly reports from the Indiana Client Eligibility System (ICES) that will reflect cost-sharing limits at the case level. Monthly, these reports will be compared to premium payment reports provided by the premium collection vendor. We will monitor MCOs for co-payment activity to confirm none are made or to track amounts per enrollee. Using this information the office will be able to determine which enrollees are within range, yet under the cost-sharing maximum. Those enrollees who have accumulated premium payment and co-payment liability within 4% of their annual income will be notified of their status and advised to stop premium payments and co pays, and to submit their records for review and confirmation of non-payment status. After payment record review and non-payment status