Two Philadelphia PhD students became so frustrated in their efforts to enroll their baby in Pennsylvania's Children's Health Insurance Program (CHIP), that they documented their quest in a 3,000-word article just published in the May issue Health Affairs-- a leading national journal of the academic.
Pennsylvania Medicaid & CHIP Programs – Center For Children and Families. Pennsylvania Medicaid and CHIP Programs. Source: Modern Era Medicaid: Findings from a 5. State Survey of Eligibility, Enrollment, Renewal, and Cost- Sharing Policies in Medicaid and CHIP as of January 2. Note: Tables below present rules in effect as of January 1, 2. The FPL for a family of three in 2. The FPL for an individual in 2. January 2. 01. 5 income limits reflect MAGI- converted income standards, and include a disregard equal to five percentage points of the FPL applied to the highest income limit for the group. In some states, eligibility limits for Section 1. FPL equivalents calculated from these dollar limits. As of January 1, 2. AZ, AR, CA, CO, CT, DE, HI, IL, IA, KY, MA, MD, MI, MN, ND, NH, NJ, NM, NV, NY, OH, OR, PA, RI, VT, WA, and WV) and DC had adopted the Medicaid expansion. The Children’s Health Insurance Program (CHIP) is a state and federally funded health insurance program that provides health insurance coverage to uninsured children who meet eligibility guidelines and are residents of Pennsylvania residing in the Independence. Eligibility Children’s Health Insurance Program (CHIP) Overview. Children's Health Insurance Program (CHIP) Overview CHIP, brought to you by Highmark Blue Shield, provides comprehensive health care coverage to eligible children and teens in the 21 counties of central Pennsylvania. CHIP is available in Pennsylvania to any. For more information, see Kaiser Family Foundation, . Arkansas, Iowa, Michigan, and Pennsylvania have approved Section 1. Medicaid expansions. To be eligible in the infant category, a child has not yet reached his or her first birthday; to be eligible in the 1- 5 category, the child is age one or older, but has not yet reached his or her sixth birthday; and to be eligible in the 6- 1. Waiting periods generally apply to separate CHIP programs only, as they are not permitted in Medicaid without a waiver. The ACA limits waiting periods to no more than 9. States may adopt additional exceptions to the waiting period, which vary by state. In addition to the income exemptions shown, specific categories of children such newborns may be exempt from the waiting periods. Income eligibility for the buy- in program is based on 2. FPLs). January 2. MAGI- converted income standards and include a disregard equal to five percentage points of the FPL. Under the option, states may receive federal funding to extend CHIP eligibility where the state has maintained its contribution levels for health coverage for employees with dependent coverage or where it can demonstrate that the state employees. Arkansas covers these children under its ARKids B waiver. Mississippi and North Carolina cover dependents of state employees and are exempt from limitations on such coverage because there is no employer contribution for dependent coverage. This column indicates whether the state has elected the option to also provide Medicaid coverage to former foster youth up to age 2. Medicaid in another state as of their 1. N/A responses indicate that the state does not provide CHIP coverage to pregnant women. For State- based Marketplace (SBM) states, such a portal may be either exclusive to Medicaid or integrated with the Marketplace. For Federally- facilitated Marketplace (FFM) and Partnership- Marketplace states, state Medicaid agency portals are indicated. Only in cases where there is no electronic data source for a type of income are states able to accept self- attestation of income without verification. In these cases, any difference does not impact eligibility. If the data are not consistent, states have the option to apply a reasonable compatibility standard by establishing a threshold (e. States have the option to set different standards based on whether the applicant. In both cases, if the difference between the attested income and the electronic data source are within the reasonably compatible standard, the state will process eligibility based on the individual. If the applicant reports income below the standard and the electronic source indicates income above the standard, and the difference is not reasonably compatible, the state may accept a reasonable explanation and/or request paper documentation. If the applicant reports income above the Medicaid or CHIP limit but the electronic source reflects income below, and the data are not reasonably compatible, the state may accept a reasonable explanation, request paper documentation, or determine the individual ineligible and transfer the application to the Marketplace. This table does not reflect state implementation of ACA required hospital presumptive eligibility, which allows hospitals to conduct presumptive eligibility determinations to expedite access to Medicaid coverage, regardless of whether a state has otherwise adopted presumptive eligibility. States are designated as having ELE if they have an approved and implemented State Plan Amendment from CMS. States are designated as having ELE at renewal if they have an approved and implemented State Plan Amendment from CMS. States running an SBM are responsible for performing all Marketplace functions, except for three SBM states (NV, NM, OR) that rely on the FFM information technology (IT) platform for eligibility determinations. In a Federally- facilitated Marketplace (FFM), the. US Department of Health and Human Services (HHS) conducts all Marketplace functions. States with a Partnership Marketplace may administer plan management functions, in- person consumer assistance functions, or both, and HHS is responsible for the remaining Marketplace functions. In assessment states, applicants. In determination states, the FFM makes a final Medicaid/CHIP eligibility determination and transfers the account to the state Medicaid/CHIP agency for enrollment. States marked as N/A operate a full SBM. Medicaid enrollees, including children, pregnant women, parents and the adult expansion group, with incomes below 1. FPL) may not be charged premiums without a waiver. Cost- sharing generally is not allowed for children with incomes below 1. FPL. Medicaid enrollees with incomes above 1. FPL can be charged premiums and relatively higher cost- sharing compared to those at lower incomes. Cost- sharing cannot be charged for preventive services for children or emergency, family planning, and pregnancy- related services in Medicaid. Overall premium and cost- sharing amounts for all family members enrolled in Medicaid may not exceed 5% of household income. States have somewhat greater flexibility to charge premiums and cost- sharing for children covered by CHIP, although there remain federal limits on the amounts that can be charged, including the overall 5% of household income cap. Medicaid enrollees, including children, pregnant women, parents and the adult expansion group, with incomes below 1. FPL) may not be charged premiums without a waiver. Medicaid enrollees with incomes above 1. FPL can be charged premiums and relatively higher cost- sharing compared to those at lower incomes. Overall premium and cost- sharing amounts for all family members enrolled in Medicaid may not exceed 5% of household income. States have somewhat greater flexibility to charge premiums and cost- sharing for children covered by CHIP, although there remain federal limits on the amounts that can be charged, including the overall 5% of household income cap. N/A indicates that coverage is not available at the specified income level. If a state does not charge premiums at all, it is noted as “- - “. The average amount is shown. If premiums are charged in Medicaid, a state must provide a 6. CHIPRA required states to provide a minimum 3. CHIP before cancelling a child’s coverage. Lock- outs are not permitted in Medicaid and the ACA limited such lock- out periods in CHIP to no more than 9. Cost- sharing generally is not allowed for children with incomes below 1. FPL, though charges may be imposed for non- emergent use of the emergency room and non- preferred drugs. Medicaid enrollees with incomes above 1. FPL can be charged premiums and relatively higher cost- sharing compared to those at lower incomes. Cost- sharing cannot be charged for preventive services for children or emergency, family planning, and pregnancy- related services in Medicaid. Overall premium and cost- sharing amounts for all family members enrolled in Medicaid or CHIP may not exceed 5% of household income. Some states require 1. Medicaid. These data are not shown. In New Mexico, the emergency room copayment is waived if the child is admitted, but the inpatient copayment is still applied. In New Mexico, the emergency room copayment is waived if the child is admitted, but the inpatient copayment is still applied. In general, states cannot adopt cost- sharing or premium policies that impose costs that exceed 5% of family income or that favor higher- income families over lower- income families. They also are prohibited from imposing cost sharing for well- baby and well- child care, including immunizations. Some states require 1. Medicaid. These data are not shown. Medicaid enrollees with incomes below 1. FPL) may not be charged premiums without a waiver. Adults enrolled in Medicaid may be charged cost- sharing, but charges for those below 1. FPL are limited to nominal amounts. The inpatient hospital copayment is subject to a maximum of $2. Medicaid enrollees with incomes below 1. FPL may not be charged premiums without a waiver. Adults enrolled in Medicaid may be charged cost- sharing, but charges for those below 1. FPL are limited to nominal amounts. If a state charges cost- sharing, but does not charge for the specific service or drug, it is recorded as $0; if a state does not charge cost- sharing at all, it is noted as “- - .”. Beginning in 2. 01. FPL will have a monthly premium equal to 2% of income, and no copayments except for $8 for non- emergent of the emergency room. Beneficiaries who fail to pay premiums for 9. Beneficiaries below 1. FPL will continue to have copayments according to state plan amounts.
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