Page 4

• In the separate child health program, enrollees living in geographic areas of the state with more than one managed care entity must choose a managed care entity. Enrollees in geographic areas of the State without a contracted managed care entity receive services through the PCCM until such time as a contract with a managed care entity is implemented.

Benefit Package

• Enrollees in the Medicaid expansion program receive the Medicaid benefit package.

• Enrollees in the separate child health program living in geographic areas of the State where a managed care entity has not yet been identified receive a Secretary-approved benefit package that is a Medicaid look-alike, with the addition of substance abuse services.

• Enrollees in the separate health program living in geographic areas of the State where a managed care entity has been identified receive a Secretary-approved benefit package based upon the State employee health plan, with the addition of certain mental health services and blood lead testing.

• The State provides supplemental coverage for children in the premium assistance program if the employer plan does not provide services included in the benchmark plan.

Cost Sharing

• Premiums were suspended in the separate program on April 15, 2002, and eliminated from cost-sharing requirements effective September 1, 2002.

• Families at or below 150 percent of the FPL are subject to co-payments ranging from $2 per outpatient visit to $15 per inpatient admission with an annual co-payment cap of $180. For families with incomes above 150 percent of the FPL, co-payments range from $5 to $25 with an annual co-payment cap of $350. Families track the amount they spend on co-payments and notify the State when the annual co-payment cap is met. A new card is then issued excluding these families from additional co-payments.

• American Indian and Alaska Native children are not subject to cost sharing.

State Action to Avoid Crowd Out

• If a child has had health care coverage within 4 months of application for or receipt of FAMIS services, the child will be ineligible unless good cause for discontinuing the coverage is demonstrated or if the child is pregnant.

Coordination between SCHIP and Medicaid

• A joint Medicaid/FAMIS application, which addresses specific questions about health insurance coverage or available coverage, can either be mailed to a central processing unit