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Benefit/Service Children of Caretaker Relatives Categorically Needy Children KCHIP Children – Medicaid Expansion Program

KCHIP Children – Separate Chip Program Physical Therapy Limited to 15 visits per 12 months $0 co-pay $0 co-pay $0 co-pay $0 co-pay Speech Therapy Limited to 15 visits per 12 months $0 co-pay $0 co-pay $0 co-pay $0 co-pay Hospice (non- institutional) $0 co-pay $0 co-pay $0 co-pay $0 co-pay Non-Emergency Transportation $0 co-pay $0 co-pay $0 co-pay $0 co-pay Chiropractic Services Limited to seven visits per 12 months $0 co-pay $0 co-pay $0 co-pay $0 co-pay Prescription Drugs $0 co-pay $0 co-pay $1 generic $2 preferred $3 non-preferred brand prescriptions $1 generic $2 preferred $3 non-preferred brand prescriptions Emergency Room $0 co-pay $0 co-pay 5% coinsurance for non- emergency use 5% coinsurance for non- emergency use Hearing Aids $1,400 maximum per ear every 36 months $0 co-pay $0 co-pay $0 co-pay $0 co-pay Audiometric Services One audiologist visit per 12 months $0 co-pay $0 co-pay $0 co-pay $0 co-pay Vision Services $400 maximum on eyewear per 12 months $0 co-pay $0 co-pay $0 co-pay $0 co-pay Prosthetic Devices $1,500 maximum per 12 months c $0 co-pay $0 co-pay $0 co-pay