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• New York estimates that an additional 18,500 children will immediately be made eligible in CHIP as a result of the CHIPRA section 214 eligibility expansion. The State anticipates that an additional 360 children will become eligible in FFY 2010 through this option.

Administration

• The New York Department of Health (DOH) administers CHPlus. Insurers are chosen to participate in the program through a competitive request for proposals (RFP) process and contract with the State to provide a managed care product. Approved New York State Medicaid Managed Care insurers may participate in the CHPlus without a competitive bid or the RFP process.

Health Care Delivery System

• New York uses a managed care insurance product to deliver health services to CHPlus members. Children have primary care providers who coordinate all health care, including referrals to specialists. To the extent possible, CHPlus providers are also Medicaid providers, to ensure a link between Medicaid and CHPlus. Insurers are selected in every geographic region of the State to assure statewide coverage.

Benefit Package

• The benefit package for enrollees in the separate child health program is the comprehensive benefit package offered under the State-funded CHPlus program that was in effect prior to the establishment of the State CHIP, plus several added benefits, including durable medical equipment, inpatient and outpatient mental health, speech therapies, and some non- prescription medications. The fourth amendment added non-airborne pre-hospital emergency medical services provided by an ambulance service, and the fifth amendment added a hospice benefit.

Cost Sharing

• Cost sharing is limited to premiums for families with income above 160 percent of the FPL. Families with income between 160 percent and 222 percent of the FPL pay premiums of $9 per child per month to a family maximum of $27 per month. Families with income between 223 percent and 250 percent of the FPL pay premiums of $15 per child per month to a family maximum of $45 per month.

• Effective July 1, 2009, premiums for children having gross family incomes from 251 through 300 percent of the FPL will be increased from $20 per month per child, with a family maximum of $60 per month, to $30 per month per child, with a family maximum of $90 per month. For those with family incomes from 301 through 350 percent of the FPL, premiums will be increased from $30 per month per child, with a family maximum of $90 per month, to $45 per month per child, with a family maximum of $135 per month. Children having family incomes from 351 through 400 percent of the FPL will have premiums increased from $40 per month per child, with a family maximum of $120 per