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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:

Effective November 1, 2003 all families in the KCHIP Separate Insurance Program will be required to pay a $20.00 per month per family premium payment. This includes families with income from 151-200% of the FPL. If a quarterly or semi-annual payment is made, the family will receive a 10% discount on their premium.

8.2.2. Deductibles:

Not Applicable

8.2.3. Coinsurance or copayments:

All enrollees will be subject to the following copayments: $1, $2, or $3 for prescriptions, $2 for office visit and testing for allergy services, and 5 percent of cost of service/co- insurance for non-emergency use of emergency room. $ 1 will be for preferred generics, $2 will be preferred brands and $3 is for non-preferred drugs. The total out of pocket medical costs will be capped at $225 per 12 months and total pharmacy out of pocket maximum will be capped at $225 per 12 months.

Exemptions are: pregnant women through 60-day postpartum period, residents of nursing homes, personal care homes, family care homes and intermediate care facilities for people with mental retardation, hospice patients, foster care children, American Indians/Alaskan Natives and enrollees receiving contraceptives. Passport Health Plan, Kentucky’s managed care partnership, began collecting these same co-payments, with the same recipient exemptions, in June 2003. Passport is not required to have providers collect co-payments on all identified services, but they can only consider those amounts identified herein. The capitated rate paid to managed care entities will be reduced by the amount of projected copayments. Other: