Pennsylvania's Medicaid and CHIP Programs for Children: At a Glance
| Implementation Date |
n/a |
March 1, 2007 (received CMS approval on 2/20/07) |
| Program Type |
Separate Medicaid and SCHIP programs; SCHIP called CHIP |
Expansion of CHIP |
| Income Range and Population |
Medicaid: ages 0-1, incomes up to 185% of the federal poverty level (FPL); ages 1-5, incomes up to 133% of the FPL; ages 6-18, incomes up to 100% of the FPL CHIP: ages 0-18, incomes up to 235% of the FPL |
CHIP: ages 0-18 with incomes up to 300% of the FPL; families with incomes above 300% can buy into the program if they meet certain requirements |
| Cost-Sharing |
Medicaid: no cost-sharing provisions SCHIP: monthly family premiums with income greater than 200% FPL (amount varies by health plan); no co-payments |
Children with family income between 200-250%, are subsidized at 75% of the per member, per month premium; co-payments ranging from $5-$10 for doctor visits, $25 for non-emergent use of the emergency room and $6-$9 for prescriptions 250-275%: subsidized at 65% of the premium cost; same co-payments as 200-250% 275-300%: subsidized at 60% of the premium cost; same co-payments as 200-250% Families with incomes greater than 300% can buy into the program at the full premium cost; co-payments ranging from $15-$25 for doctor visits, $50 for non-emergent use of the emergency room and $10-$18 for prescriptions |
Enrollment/Renewal Procedures
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| Application |
Joint application; no face-to-face interview or asset test required for Medicaid or CHIP; on-line application |
No change |
| Continuous Eligibility |
12-months for CHIP |
No change |
| Renewal |
6-month renewal for Medicaid, 12-month renewal for CHIP; no face-to-face interview for either program |
No change |
| Crowd-out Measures |
No waiting period for Medicaid or CHIP |
With exceptions, a children ages 2-18 with family income above 200% of the FPL must be uninsured for at least six months prior to application |
Benefits
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| Benefits |
Among other things, benefit packages includes preventive care, immunizations, emergency care, dental, vision, hearing, prescription drugs and mental health benefits |
No change |
| Service Delivery System |
Managed care or fee-for-service depending upon the county |
No change |
Other Provisions
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| Premium Assistance |
Was not authorized in the previous CHIP |
Authorized by statute, but not yet approved by CMS |
Last Updated: February 2008
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