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Charges Type of Cost Sharing At or below 100% FPL 101- 150% FPL 151- 185% FPL 186 - 200% FPL Monthly Premium (per family per month) $0 $0 $0 $0 Enrollment Fee N/A N/A $35 every 12- month period of eligibility $50 every 12- month period of eligibility Office Visit $3 $5 $7 $10 ER $3 $5 $50 $50 Generic Drug $0 $0 $5 $5 Brand Drug $3 $5 $20 $20 Inpatient Copayment $10 $25 $50 $100 *There may be children with incomes less than 100 percent FPL because of the State's Medicaid assets test.

Crowd-Out Strategy

• Children must be uninsured for at least three months to enroll in the separate child health program unless the child qualifies for an exception to the waiting period. Exceptions include: termination of employment because of a layoff or business closing; change in marital status of a parent of the child; and the family terminated health benefits plan coverage for the child because the cost to the child's family for the coverage exceeded 10 percent of the family's income.

• The 3-month crowd-out period will not apply to eligible unborn children.

Coordination Between SCHIP and Medicaid

• Coordination with Medicaid is achieved through coordinated outreach efforts and a joint children’s application. Applications are sent to a Medicaid eligibility worker for a Medicaid determination and a Medicaid database is also checked to ensure that the child is not already enrolled in Medicaid.

State Outreach Activities

• TexCare Partnership applications are available on-line and in community centers across the State. Texas provides referral services to potentially eligible individuals who make benefit inquiries when telephoning the State's TexCare Partnership

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