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Model Application Template for the State Children’s Health Insurance Program

Effective Date:

Approval Date: 49 9.10. Provide a one year projected budget. A suggested financial form for the budget is attached. The budget must describe: (Section 2107(d)) (42CFR 457.140) • Planned use of funds, including -- - Projected amount to be spent on health services; - Projected amount to be spent on administrative costs, such as outreach, child health initiatives, and evaluation; and - Assumptions on which the budget is based, including cost per child and expected enrollment. (See Note 2) • Projected sources of non-Federal plan expenditures, including any requirements for cost-sharing by enrollees.

The budget figures reported below are in addition to those reported in Nebraska's Phase I Plan and assume a start date of September 1, 1998.

The estimated costs used in the budget for this program are based on current Medicaid experience. Estimates were prepared on a State fiscal year basis (July 1 - June 30) and adjusted to the Federal fiscal year (FFY) for this plan. It assumes full participation in the third year with 2/3 of a full year in the first year. The second year is a midpoint between year one and year three. The cost per child is based on our current experience, adjusted down with the assumption that these children may be less expensive than the current Medicaid population. Annual increases also reflect adjust for inflation.

Approximately 1,250 new children would be added in FFY 1998; 12,450 in FFY 1999; and 16,050 in FFY 2000 due to increasing the Medicaid standard up to 185% of poverty. Program costs for children related to the change in eligibility standard are estimated at $67,200 in FFY 1998; $9,262,000 in FFY 1999; and $15,621,800 in FFY 2000.

It is estimated that approximately 250 additional children would be eligible in FFY 1998 through presumptive eligibility; 2,450 in FFY 1999; and 3, 100 in FFY 2000. Program costs for children eligible related to presumptive eligibility are estimated at $69,400 in FFY 1998; $1,912,500 in FFY 1999; and $3,040,900 in FFY 2000.

Twelve months continuous eligibility would allow eligible children to be on for 12 months before having eligibility redetermined. It is estimated that no new children would be added each month due to 12 months continuous eligibility. However, children would be eligible for medical services for longer periods of time. It is estimated that the additional months of eligibility would cost $381,000 in FFY 1999 and $600,500 in FFY 2000.