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Effective Date: April 1, 2009

Approval Date: ____________ 44

Section 8. Cost Sharing and Payment (Section 2103(e))

Check here if the state elects to use funds provided under Title XXI only to provide expanded eligibility under the state's Medicaid plan, and continue on to Section 9.

8.1. Is cost-sharing imposed on any of the children covered under the plan? (42CFR 457.505)

8.1.1.

YES 8.1.2.

NO, skip to question 8.8.

8.2. Describe the amount of cost-sharing, any sliding scale based on income, the group or groups of enrollees that may be subject to the charge and the service for which the charge is imposed or time period for the charge, as appropriate. (Section 2103(e)(1)(A))

(42CFR 457.505(a), 457.510(b) &(c), 457.515(a)&(c))

As indicated above, Title XXI coverage in New Jersey provides for coverage that serves to transition families from the traditional Medicaid program for children’s health coverage to traditional commercial coverage as income rises. The program recognizes the need for affordability and simplicity in order to encourage maximum coverage of currently uninsured children, while also valuing the need for personal responsibility. Therefore, the cost sharing requirements have been designed to complement these overall policy goals. The premiums established in the State's premium assistance program are set lower than the premiums in the NJFC program, to assist in achieving this goal.

8.2.1. Premiums: For children in families with income at or below 150% of the poverty limit, there will be no premiums. The absence of a premium requirement applies to all children covered through the Medicaid expansion and those children covered under Title XXI with income at or below the 150% level.

For children in families with gross income above 150% and at or below 200% of the federal poverty level, a monthly premium will be required. There will be a single premium of $18.50 per month that applies to all families, regardless of income and regardless of the number of children in the family. A premium structure with limited tiers promotes affordability and simplicity, which will serve to attract greater enrollment of uninsured children. A family that has a higher number of children and an income at the higher end of the allowable scale will pay less when measured as a percentage of family income, but in fixed dollar terms the premium structure does not favor higher income families over lower income families.