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Effective Date:

Approval Date:

Updated and amended effective August 24, 2001

7

FPL. The free and subsidized programs are funded by State and Federal funds. Families whose income is greater than 300% FPL may purchase the CHIP benefit package at the rate negotiated by the Commonwealth. The buy- in program is not supported through State or Federal funds. Additionally, utilization experience of the buy-in program is not included in rate setting for the free and subsidized programs.

The Program is administered by the Pennsylvania Insurance Department (see Appendix A, the Act , Section 2311(G)(1)). In addition, the Act provides for a Children’s Health Advisory Council. The Council consists of fourteen voting members, seven (7) of whom appointed by the Insurance Commissioner. The Council also includes the Secretary of Health, the Insurance Commissioner, the Secretary of Public Welfare, or their respective designees (see Appendix A, the Act , Section 2311 (I)). Its primary functions are to review outreach activities; and to review and evaluate the accessibility and availability of services to children enrolled in the program.

B. Public Insurance Program

Pennsylvania has operated a categorically and medically needy Medicaid program for many years. However, major program expansions have occurred.

In 1988, the State implemented Federally-mandated coverage for pregnant women and qualified children. This coverage was designated as Healthy Beginnings. Healthy Beginnings provides medical coverage to pregnant women and infants up to age one (Income Standard: 185% FPL); children ages one to six (Income Standard: 133% FPL); and children ages six and born after September 30, 1983 (Income Standard: 100% FPL). Early periodic screening, diagnosis and treatment provide comprehensive health services to all persons under age 21 who are receiving Medicaid. These services include check-ups and follow-up care. Pennsylvania has also elected to provide presumptive eligibility to pregnant women thereby encouraging early prenatal care and providing payment for outpatient primary care expenses incurred during pregnancy.

See Appendix C for the number of children currently enrolled in CHIP and Medicaid

C. Private Health Insurance Programs for Low Income Families

Special Care Program

Description: Special Care is a low cost insurance plan offered statewide to low-income residents by Pennsylvania Blue