Page 6

month, to $60 per month per child, with a family maximum of $180 per month. These premium increases do not exceed the 5 percent cap on cost sharing.

• There are no deductibles or copayments.

• American Indians/Alaskan Native children are exempt from cost sharing.

Coordination between CHPlus and Medicaid

• The State has a common application form, “Access New York (NY) Health Care,” for both children and adults applying for Medicaid, CHPlus, or Family Health Plus. Children applying for health insurance are screened first for Medicaid, and if found ineligible, are screened for CHPlus. Previously, New York had another common application form named “Growing Up Healthy” (GUH), which was used exclusively for families applying for Medicaid or CHPlus for their children, but not for adults. The State no longer uses the GUH application form.

• New York has contracted with 41 “facilitated enrollers,” responsible for assisting families in applying for and enrolling in Medicaid or CHPlus. Facilitated enrollers provide families with eligibility and application information for both Medicaid and CHPlus, process applications for children who appear to be eligible for CHPlus, and submit applications to local social services offices when children appear to be eligible for Medicaid.

• To the extent possible, CHPlus providers are also Medicaid providers, allowing children to move between insurance programs without changing providers.

Crowd-Out Strategy for Children at or Below 250 Percent of the FPL

• The State monitors prior insurance of applicants to ensure the program does not substitute for coverage under group health plans. The State collects information quarterly from the plans on prior health insurance status to detect potential crowd out. In addition, the responsible adult completing an application must attest to the source and nature of any health care coverage the child is receiving or has received in the past 6 months.

• Data will be analyzed quarterly to determine whether crowd out is occurring. The State will impose a required period of uninsurance if the State finds that greater than 8 percent of total enrollment has dropped employer-based health insurance to enroll in CHPlus.

Crowd-Out Strategy for Children Above 250 Percent of the FPL

• There is a 6-month waiting period of prior uninsurance for children with family incomes above 250 percent of the FPL with ten allowable exceptions.

• Exceptions to the 6-month waiting period will be allowed for the following situations: when the family has experienced the involuntary loss of employer-based coverage for one of seven specific reasons; when the applicant child is pregnant; when the applicant child is at or below