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4 Cost Sharing

• Maine’s separate child health program has a sliding scale for premiums for children with family incomes above 150 percent up to and including 200 percent of the FPL according to the following schedule:

o Above 150 up to and including 160 percent FPL: premiums are $8 per month for the first child and $16 per month for two or more children. o Above 160 up to and including 170 percent FPL: premiums are $16 per month for the first child and $32 per month for two or more children. o Above 170 up to and including 185 percent FPL: premiums are $24 per month for the first child and $48 per month for two or more children. o Above 185 up to and including 200 percent FPL: premiums are $32 per month for the first child and $64 per month for two or more children.

Coordination between Separate Child Health Program and Medicaid

• Applicants for both programs use the same simplified eligibility form and enrollment process, which is conducted by the Office of MaineCare Services (OMS). Those determined to be Medicaid-eligible are enrolled in Medicaid. Children enrolled under title XXI criteria will be given distinct eligibility codes in order to track coverage under both programs.

Crowd-Out Strategy

• The joint application requests information about current and prior insurance coverage for the most recent 3-month period. If applicants have lost coverage for reasons related to the availability of CHIP, eligibility for the separate child health program will be denied. Children who lost coverage for reasons unrelated to CHIP will remain eligible. If the coverage termination complies with the following guidelines the children will be eligible for the separate child health program:

o The cost of the employee’s share of family coverage exceeds 10 percent of family income. o The employer plan does not pay at least 50 percent of the cost of the child’s coverage. o The Department determines that good cause exists for dropping the employer-based coverage.

Outreach Activities