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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))

8.2.1 Premiums: None 8.2.2 Deductibles: None 8.2.3 Coinsurance or copayments:

Children will be subject to copayments for most services provided under the plan; however, no copayments will be charged for well- child visits, immunizations, or lab and x-ray services. There is also no copayment for ambulance services when deemed medically necessary by the health plan. For children in families with income at or below 150 percent of the FPL, co-payments will not exceed $5.00, except the copayment for non-emergency use of the emergency room will be $10. Copayments for children in families with income above 150 percent of the FPL will vary by service. Attachment A details the copayments for each income group.

8.2.4 Other: None

8.3 Describe how the public will be notified, including the public schedule, of this cost sharing (including the cumulative maximum) and changes to these amounts and any differences based on income. (Section 2103(e)((1)(B)) (42CFR 457.505(b))

Families of applicants and enrollees, providers, and the public will be informed of the cost-sharing requirements (including the cumulative maximum) in the CoverKids application and enrollment materials. Copayments are listed in the benefits booklet. Outreach workers and administrative staff who answer phone inquiries are trained to discuss with

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