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• $5 for non-well primary care visits, • $10 for specialists, • $25 for emergency care, • $6 for generic prescriptions, and • $9 for brand name prescriptions.

Coordination between CHIP and Medicaid

• PA CHIP managed care contractors and local Medicaid offices accept applications for the CHIP program. If the application is sent to a managed care contractor, the contractor first screens applicants for Medicaid. If the applicant appears to be Medicaid eligible, the managed care contractor forwards the application to the appropriate Medicaid eligibility office and notifies the family that the application has been forwarded. If the application is sent to a local Medicaid office, the office first determines Medicaid eligibility. If the application is denied for Medicaid, it is sent to a PA CHIP managed care contractor for CHIP determination. Families are also notified in this instance that they have been denied for Medicaid but that their application has been forwarded to PA CHIP.

• Eligibility criteria for Medicaid and PA CHIP are comparable in order to simplify the screening process. There are also several official versions of an application for health care benefits that can be used for determination of eligibility for either PA CHIP or Medicaid, including a common application form for both programs.

State Action to Avoid Crowd Out

• For families below 200 percent of the FPL, the State monitors crowd-out by asking about private insurance coverage on the application and renewal form, and data matches are made against private insurance files. This data is used to monitor the amount of substitution over time.

• There are two crowd-out strategies for children above 200 percent of the FPL.

o Children who are two years of age and older will be subject to a six-month period of uninsurance. o Children under age two will be monitored for substitution of coverage with a trigger rate, at which point a period of uninsurance will be imposed. The State is implementing this monitoring strategy to ensure that children in this younger age group receive the 11 developmental assessments and the 21 immunizations recommended during this time period by the American Academy of Pediatrics and the Centers for Disease Control and Prevention.

Outreach Activities

• Each of the health insurance companies under contract provides a range of outreach activities. Outreach activities include canvassing local businesses, day care centers, school districts, hospitals, providers, legislative offices, religious organizations and churches, social service agencies, unions, and civic groups.