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8.2.3 Coinsurance or copayments:
Description of Children Affected
Premium Co-payments Children ages 1 - 5 with incomes >185 FPL up to and including 200% FPL None See Attachment 1, included at the end of Section 8 Children ages 6 - 18 with incomes > 150% FPL up to and including 200% of FPL None Children ages 1 - 18 with incomes from 200 - 300% FPL 200 < 230% FPL - $10 230 < 240% FPL - $15 240 < 250% FPL - $23 250 < 260% FPL - $34 260 < 270% FPL - $44 270 < 280% FPL - $55 280 < 290% FPL - $68 290 - 299.99% FPL - $82 300% FPL – $97.53 See Attachment 2, included at the end of Section 8
No cost sharing will be applied to unborn children.
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)) (42 CFR 457.505(b))
Outreach and application forms will include this information. Sections 2.2.1, 5.1, and 9.9 provide detailed descriptions of our outreach efforts. In addition, the State informs providers and members (beneficiaries) of allowable cost sharing amounts via Provider Updates and member Enrollment and Benefits booklet.
8.4 The state assures that it has made the following findings with respect to the cost sharing in its plan: (Section 2103(e))
8.4.1 Cost-sharing does not favor children from higher income families over lower income families. (Section 2103(e)(1)(B)) (42 CFR 457.530) 8.4.2 No cost-sharing applies to well-baby and well-child care, including age- appropriate immunizations. (Section 2103(e)(2)) (42 CFR 457.520) 8.4.3 No additional cost-sharing applies to the costs of emergency medical services delivered outside the network. (Section 2103(e)(1)(A)) (42 CFR 457.515(f))
WISCONSIN
Effective Date:
Approval Date: 41