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19 Effective Date: July 1, 2009

Approval Date: Section 3. Methods of Delivery and Utilization Controls (Section 2102)(a)(4))

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 4.

3.1. Describe the methods of delivery of the child health assistance using Title XXI funds to targeted low-income children. Include a description of the choice of financing and the methods for assuring delivery of the insurance products and delivery of health care services covered by such products to the enrollees, including any variations. (Section 2102)(a)(4) (42CFR 457.490(a))

Washington’s CHIP uses Washington’s Medicaid managed care delivery system. The managed care system contracts with managed care organizations (MCOs) for medical care coverage and a limited mental health benefit for enrollees that do not meet the criteria for primary mental health care services from the Regional Support Networks (RSN’s). Other Medicaid services are “carved out” of managed care and provided on a “wrap-around” fee-for-service (FFS) basis. These “wrap around” services include dental coverage, chemical dependency services, eyeglasses, hearing aid devices, pregnancy terminations, and non-emergent transportation. Children also receive services through MPA’s FFS program prior to enrollment in managed care. MPA contracts with MCOs registered with the state’s Office of the Insurance Commissioner (OIC) to provide full-scope medical coverage on a full-risk capitation basis. This program is called Healthy Options (HO). If MPA does not contract with at least two MCOs for coverage in a given service area, or if the contracting plan’s networks are not able to provide sufficient access throughout the county, enrollees will be allowed to receive coverage through FFS.

In service areas with a choice of at least two MCOs, CHIP enrollees will be required to enroll in an MCO and will receive the same schedule-of-benefits as Medicaid clients.

An CHIP household is not required to select a HO plan for their child as part of the application process. However, after approval of the application, if a client does not