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Model Application Template for the State Children’s Health Insurance Program
Effective Date:
Approval Date: 57
Benefits
Reporting Period FY 2005 Next Fiscal Year 2006
Insurance payments $275,812,039 $291,477,782 Managed Care
Per member/Per month rate @ # of eligibles $168.85 $196.74 Fee for Service
Total Benefit Costs
(Offsetting beneficiary cost sharing payments)
Net Benefit Costs $275,812,039 $291,477,782
Administrative Costs
Personnel $51,695 $69,427 General Administration $6,629,724 $1,424,251 Contractors/Brokers (e.g., enrollment contractors)
Claims Processing
Outreach/Marketing costs $550,935 $936,594 Other
Total Administration Costs $7,232,354 $2,430,272 10% Administrative Cap (net benefit costs ÷ 9) $30,645,782 $32,386,420
Federal Title XXI Share $210,981,291 $218,785,155 State Share $72,063,102 $75,122,899 TOTAL COSTS OF APPROVED SCHIP PLAN $283,044,393 $293,908,054
co-payments and enrollment feeds do not generate “offsetting costs.” Enrollment fees are kept by the counties to partially compensate them for eligibility determination. No county participation is required in the NC Health Choice benefits payment. Co-payments are kept by providers who are then paid at a reduced rate by the claims payer. (For example, physicians keep co-pays paid to them, pharmacists keep co-payments made to them and hospitals keep co-pays paid to them.) During federal fiscal year 2004, a total of $2,079,317.79 was collected by counties in enrollment fees. Providers collected $234,194.31 in co-payments from those at or below 150% FPL (beginning February 2004) and $2,067,374.27 from those from 151% to 200% FPL.