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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))

It is not anticipated that cost sharing will exceed 5 percent of the family’s annual income for any family with enrolled children. The total amount of cost sharing for both medical and pharmacy services will not exceed $450.

8.6 Describe the procedures the state will use to ensure American Indian (as defined by the Indian Health Care Improvement Act of 1976) and Alaska Native children will be excluded from cost sharing. (Section 2103(b)(3)(D)) (42CFR 457.535)

Kentucky will rely on self-reporting to ensure American Indian and Alaskan Native children are excluded from cost sharing. During the application process in the local DCBS office the worker asks the recipient their race/ethnicity. The computer system automatically generates the medical card for American Indians or Alaska Natives without an indicator requiring co-pays. The eligibility on-line system automatically exempts anyone identifying herself or himself, as American Indian or Alaskan Native from paying a premium. Cards for all American Indians and Alaskan Natives that were active members at the time the policy went into effect were also automatically generated without the indicator requiring the co-payment and without receiving a billing notice for premium payments.

8.7 Please provide a description of the consequences for an enrollee or applicant who does not pay a charge. (42CFR 457.570 and 457.505(c))

Enrollees in KCHIP are given written notice concerning the consequences of non-payment of premiums. When a KCHIP family fails to make the second premium payment, receipt of medical benefits will end at the end of the month of service for which no premium payment was made. The department shall give written notice of and an opportunity to pay past due premium prior to discontinuance of benefits for non-payment of a premium. For example, a family remits premium payment in November for December coverage. If the family does not pay for December or January, their coverage will be cancelled at the end of December. If the family reports income at or below 150% FPL the family will no longer be required to pay a premium and their medical coverage will continue. To re-enroll, the family must pay the one missed payment and a current monthly payment. There are no lockout periods in Kentucky.

8.7.1 Please provide an assurance that the following disenrollment protections are