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47 Effective Date: July 1, 2009
Approval Date: 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? (42 CFR 457.505) 8.1.1.
YES, except for American Indians/Alaska Natives, who are exempt from this requirement. 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: Households with income above 200% FPL, but not above 300% FPL, are required to pay a monthly premium for each enrolled child; up to a family maximum premium amount for two children. The premium amount will be based on the household’s income as indicated by the following Tiers:
Tier 1 (200%-250%FPL)
Tier 2 (251%-300%FPL) In January, 2009 these premiums will be:
Tier 1 - $20/mo. per child; up to a family maximum of $40/mo.
Tier 2 - $30/mo. per child; up to a family maximum of $60/mo. Payments can be made for periods greater than one month. Eligibility will end if premiums are not paid for three consecutive months.
Households with enrolled children will receive monthly billing statements. These monthly statements include the current amount as well as any overdue amount. The statement includes a note that informs the client that accounts over 90 days past due may result in loss of medical coverage. A phone number is provided with a notation