A State-by-State Compilation of Key State Childrens Health Insurance Program (SCHIP) Characteristics

CRS Report for Congress
A State-by-State Compilation of Key State
Children’s Health Insurance Program
(SCHIP) Characteristics
May 19, 2004
Elicia J. Herz
Specialist in Social Legislation
Domestic Social Policy Division
Evelyne Baumrucker
Analyst in Social Legislation
Domestic Social Policy Division
Peter Kraut
Contractor
Domestic Social Policy Division

Congressional Research Service ˜ The Library of Congress

A State-by-State Compilation of Key State Children’s
Health Insurance Program (SCHIP) Characteristics
Summary
The Balanced Budget Act of 1997 (BBA 97; P.L. 105-33) established the State
Children’s Health Insurance Program (SCHIP) under a new Title XXI of the Social
Security Act. In general, SCHIP provides states with federal matching funds to cover
uninsured children in families with income that is above Medicaid eligibility levels.
To date, the upper income eligibility limit under SCHIP has reached 350% of the
federal poverty level or FPL (in one state).
States may choose among three options when designing their SCHIP programs.
They may expand Medicaid, create a new “separate state” insurance program, or use
a combination of both approaches. All 50 states and the District of Columbia have
SCHIP programs in operation. As of June 30, 2003, among these 51 jurisdictions,
15 were Medicaid expansions, 18 were separate state programs, and 18 used a
combination approach.
Medicaid expansion programs must provide all mandatory benefits and covered
optional services offered in the state’s Medicaid program. Cost-sharing is prohibited
for children. Separate state programs must follow certain coverage and benefit
options outlined in SCHIP law. While cost-sharing provisions in separate state
programs vary by family income in a number of states, the total annual aggregate
cost-sharing (including premiums, enrollment fees, deductibles, copayments,
coinsurance, and other similar charges) for any family may not exceed 5% of total
income in a year. Preventive services are exempt from cost-sharing.
States must ensure that SCHIP does not substitute for coverage under group
health plans, a phenomenon known as “crowd-out.” The primary method for
preventing substitution is requiring a waiting period during which applicants must
be uninsured prior to enrollment in SCHIP.
States that want to make changes to their SCHIP programs that go beyond what
the law allows may do so through what is called a Section 1115 waiver. These
waivers allow states to use SCHIP funds to cover populations not normally covered
under SCHIP, such as pregnant women and parents of SCHIP children, as well as to
modify certain statutory provisions such as cost-sharing limitations and benefit
requirements.
This report provides an overview of state program characteristics under SCHIP
in each of the areas summarized above (eligibility, benefits packages, cost sharing,
crowd-out prevention, and Section 1115 waivers). Several sources were used to
compile the program data shown in this report. These data represent program status
as of December 31, 2002 through July 31, 2003, depending on the source.
Information is summarized across states, and detailed, state-specific fact sheets are
also provided.

Contents
Eligibility ........................................................1
Financial Eligibility Standards....................................2
Other Eligibility and Enrollment Characteristics......................4
Benefit Packages..................................................5
Cost Sharing......................................................7
Cost-Sharing Under Medicaid Expansions..........................7
Cost-Sharing Under Separate State Programs........................8
Substitution of SCHIP for Private Health Insurance......................10
Section 1115 Waivers.............................................11
Appendices. State by State Program Characteristics.....................13
Appendix 1. Methodology.....................................14
Alabama ................................................24
Alaska .................................................25
Arizona .................................................26
Arkansas ................................................27
California ...............................................28
Colorado ................................................30
Connecticut .............................................31
Del aware ...............................................32
District of Columbia......................................33
Florida .................................................34
Georgia .................................................36
Hawaii .................................................37
Idaho ..................................................38
Illinois .................................................39
Indiana .................................................41
Iowa ...................................................42
Kansas .................................................43
Kentucky ...............................................44
Louisiana ...............................................46
Maine ..................................................47
Maryland ...............................................48
Massachusetts ...........................................50
Michigan ...............................................52
Minnesota ...............................................53
Mississippi ..............................................54
Missouri ................................................55
Montana ................................................56
Nebraska ...............................................57
Nevada .................................................58
New Hampshire..........................................59
New Jersey..............................................60

New Mexico.............................................62
New York...............................................63
North Carolina...........................................65
North Dakota............................................66
Ohio ...................................................68
Oklahoma ...............................................69
Oregon .................................................70
Pennsylvania ............................................71
Rhode Island............................................72
South Carolina...........................................74
South Dakota............................................75
Tennessee ...............................................76
Texas ..................................................77
Utah ...................................................78
Vermont ................................................79
Virginia ................................................80
Washington .............................................82
West Virginia............................................83
Wisconsin ...............................................84
Wyoming ...............................................85
List of Tables
Table 1. General Eligibility Criteria for States, as of December 31, 2002
through July 31, 2003...........................................3
Table 2. Benefits Packages in Separate State Programs, as of June 30, 2003...7
Table 3. Cost-Sharing Patterns in Separate State Programs, as of July 31, 2003.9
Table 4. Premiums/Enrollment Fees and Selected Co-Payment Amounts in
Separate State Programs, as of July 31, 2003.......................10
Appendix 2. Selected SCHIP Program Characteristics by State, as of
December 31, 2002 through July 31, 2003.........................16
Appendix 3. SCHIP Premiums/Enrollment Fees and Selected Co-Payment
Amounts by State, as of July 31, 2003............................21
Appendix 4. SCHIP State Tables, Status as of December 31, 2002 through
July 31, 2003................................................24

A State-by-State Compilation of Key State
Children’s Health Insurance Program
(SCHIP) Characteristics
The Balanced Budget Act of 1997 (BBA 97, P.L. 105-33) established the State
Children’s Health Insurance Program (SCHIP) under a new Title XXI of the Social
Security Act. The program offers federal matching funds for states and territories to
provide health insurance coverage to uninsured children from families whose annual
incomes are higher than Medicaid eligibility thresholds. Total federal funding is
nearly $40 billion for FY1998 through FY2007.
Eligibility
In general, Title XXI defines a targeted low-income child as one who is under
the age of 19 years with no health insurance, and who would not have been eligible
for Medicaid under the rules in effect in the state on March 31, 1997. States can set
the upper income level for targeted low-income children up to 200% of the federal
poverty level (FPL),¹ or if the applicable Medicaid income level for children was at
or above 200% FPL prior to SCHIP, the upper income limit may be raised an
additional 50 percentage points above that level.²
Within these general rules, states may provide medical assistance to qualifying
children in two basic ways. They may cover such children under their Medicaid
programs, and/or they may create a separate SCHIP program for this purpose. When
states provide Medicaid coverage to targeted low-income children, Medicaid rules
typically apply. When states provide coverage to targeted low-income children
through separate SCHIP programs, Title XXI rules typically apply. In both cases, the
federal share of program costs comes from federal SCHIP appropriations.

¹ For example, in 2003, the poverty guideline in the 48 contiguous states and the District of
Columbia for a family of four is $18,400. (Department of Health and Human Services,
“Annual Update of the HHS Poverty Guidelines,” 68 Federal Register 6456, Feb. 7, 2003).
² Under Medicaid, states must cover all pregnant women and children under age 6 living in
families with income at or below 133% of FPL and all children ages 6 through 18 living in
families with income at or below 100% of FPL. States also have the option of covering: (1)
pregnant women and infants with income up to 185% of FPL, (2) using more liberal income
and asset standards to determine eligibility than those required under current law for certain
groups, and (3) using waiver authority (e.g., Section 1115) to cover persons who would not
otherwise be eligible for Medicaid.

Title XXI does not establish an individual entitlement to benefits. Instead, Title
XXI entitles states with approved state plans for Medicaid coverage or separate
SCHIP programs to pre-determined federal allotments based on a distribution
formula set in the law. However, targeted low-income children covered under
Medicaid are entitled to the benefits offered under that program as dictated by
Medicaid law. These children retain their entitlement to Medicaid benefits even if
SCHIP terminates (unless the state eliminates this coverage group). No such
individual entitlement exists for targeted low-income children covered in separate
SCHIP programs.
Under Medicaid, states may cover targeted low-income children in the following
ways: (1) by establishing a new optional eligibility group for such children as
authorized in Title XXI, and/or (2) by liberalizing the financial rules for any of
several existing Medicaid eligibility categories.
States may also provide coverage to targeted low-income children by creating
a separate SCHIP program. States define the group of targeted low-income children
who may enroll in separate SCHIP programs. Title XXI allows states to use the
following factors in determining eligibility under separate state programs: geography
(e.g., sub-state areas or statewide), age (e.g., subgroups under 19), income and
resources, residency, disability status (so long as any standard relating to that status
does not restrict eligibility), access to other health insurance, and duration of SCHIP
enrollment.
As of June 30, 2003, among the 50 states and the District of Columbia, 15 were
Medicaid expansions, 18 were separate state programs, and 18 used a combination
approach.
Financial Eligibility Standards
Table 1 presents a summary of state eligibility thresholds and other eligibility³
information under SCHIP. The first column shows counts of Medicaid expansions,
the second column shows counts of separate state programs, and the last column
shows counts of states. Note that the total number of programs does not add up to
51 (the 50 states and the District of Columbia) because states with combination
programs have a Medicaid expansion and at least one separate state program.
Several states have two or more separate state programs.

³ Appendix 1 describes the information sources and methods used to compile the data
presented in this report.

Table 1. General Eligibility Criteria for States, as of December
31, 2002 through July 31, 2003
^Num^b^{er of}^Num^b^{er of}
^Me^dⁱ^c^aⁱ^d^se^pa^r^a^t^e^st^a^t^e
^expa^nsio^{ns (}³³ⁱⁿ^p^r^ogram^s⁽⁴⁴
^{33 s}^t^ates⁾ⁱⁿ^{36 s}^t^ates⁾^N^u^m^b^{er of s}^t^ates
^U^{pper i}ⁿ^com^e^l^e^v^e^l^{< 200%}^F^P^L¹⁷⁸¹²
^U^{pper i}ⁿ^com^e^l^e^v^e^l^{= 200%}^F^P^L¹¹²⁵²⁶
^U^{pper i}ⁿ^com^e^l^e^v^e^l^201-^250%^F^P^L²⁶⁶
^U^{pper i}ⁿ^com^e^l^e^v^e^l^251-^300%^F^P^L³⁴⁶
^U^{pper i}ⁿ^com^e^l^e^v^e^l^{> 300%}^F^P^L⁰¹¹
^L^o^w^e^s^t^u^{pper i}ⁿ^com^e^l^e^v^e^l^100%^140%^100%
^Hⁱ^ghe^st^up^p^e^rⁱⁿ^c^o^m^e^l^e^ve^l^b^300%^350%^350%
^B^a^sⁱ^{c in}^com^e^dis^r^eg^ard³²³²⁴⁶^a
^A^sse^{t te}^sts¹¹²
^P^r^esu^m^p^tiv^{e elig}^ib^ility⁷⁵⁹^a
^Coⁿ^tin^u^o^u^s^elig^ib^ility⁽^r^an^g^e^{s f}^r^o^m^oⁿ^e^a
^t^o¹²^m^o^nt^hs)¹³³²³⁶
^En^r^o^llm^en^{t cap}^o^r^w^a^itin^g^list⁰⁵³
^P^r^en^{atal cov}^e^rag^e^of^uⁿ^born^ch^ildren⁰⁴³
^Sources^{: See Appendix}^1.
^a.^C^o^m^bⁱⁿ^ation^s^t^ates^th^{at h}^a^v^e^th^is^ch^aracteris^{tic in}^{at leas}^{t on}^{e of}^th^{eir prog}^ram^s^areⁱⁿ^clu^d^edⁱⁿ^th^is
^c^o^unt^.
^b^.^Iⁿ^d^e^ter^mⁱⁿⁱⁿ^gⁱⁿ^co^m^e^elig^ib^ility^f^o^r^SCHI^P^an^d^Medⁱ^caid^,^so^m^e^{states ap}^p^l^y^“ⁱⁿ^c^o^m^{e d}ⁱ^sr^eg^ar^d^s^”
⁽^s^e^e^th^{e n}^e^x^t^r^o^wⁱⁿ^th^{is tab}^l^e)^{. T}^y^pⁱ^cally^,^th^es^{e are dollar am}^ouⁿ^t^s^s^u^{btracted f}^r^om^g^r^o^s^s
ⁱⁿ^co^m^e^to^co^m^p^u^t^{e n}^e^{t in}^co^m^e^w^h^ich^{is th}^en^com^p^{ared t}^o^t^h^{e s}^t^ate’^sⁱⁿ^com^e^s^t^an^{dard f}^o^r
^d^e^t^e^r^mⁱⁿⁱⁿ^g^elig^ib^ility^{. T}^h^{e n}^u^m^b^e^r^,^ty^p^e^an^d^am^o^uⁿ^t^o^f^dⁱ^sr^eg^ar^d^e^dⁱⁿ^co^m^e^v^a^rⁱ^{es f}^r^o^m
^applican^{t to applican}^t^,^d^e^p^eⁿ^dⁱⁿ^g^on^each^pers^on^’^s^s^p^ecifⁱ^{c f}ⁱⁿ^aⁿ^c^{ial circu}^m^s^t^an^ces^{. Som}^e^s^t^ates
^apply^s^e^{lected dis}^r^eg^ards^{to all applican}^ts^{. For ex}^am^{ple, in}^New^J^e^rs^ey^’^s^s^e^p^a^r^a^t^e^S^C^H^I^P
^p^r^o^g^r^a^m^,^a^l^lⁱⁿ^c^o^m^e^b^e^t^w^een²⁰⁰^t^o^350%^of^t^h^{e F}^P^Lⁱ^s^di^s^r^eg^{arded f}^o^{r ev}^ery^applⁱ^can^t^.^In
^{state SCHI}^P^p^l^an^{s an}^d^r^e^lated^d^o^c^u^m^en^tatioⁿ^,^th^{e so}^u^r^{ces f}^o^rⁱⁿ^f^o^r^m^atioⁿ^oⁿ^ap^p^licab^leⁱⁿ^co^m^e
^lev^e^{ls u}^s^edⁱⁿ^th^{is tab}^l^{e an}^d^elsew^h^er^eⁱⁿ^th^is^r^e^p^o^r^{t, it is u}ⁿ^c^lear^w^h^eth^e^r^th^{e r}^e^p^o^r^tedⁱⁿ^co^m^e
^lev^e^ls^ref^l^ect^t^h^e^a^p^p^lⁱ^c^{able s}^t^an^dards^bef^o^{re or af}^{ter in}^com^e^dis^r^eg^ards^{are applied. In}^m^o^s^t
^cas^es^{, th}^{e reported}ⁱⁿ^com^e^lev^e^ls^probably^ref^l^{ect th}^{e s}^t^an^dards^bef^o^r^e^an^yⁱⁿ^com^e^dis^r^eg^ards
^{are tak}^eⁿⁱⁿ^{to accou}ⁿ^t^.^Us^e^of^dis^r^eg^ards^incr^eas^e^s^th^e^effectiveⁱⁿ^com^e^lev^e^{l abov}^{e th}^{e s}^t^ated
^s^t^an^{dard. T}^h^{e ex}^ception^is^th^os^{e s}^t^ates^,^lik^e^New^J^e^rs^ey^,^th^at^apply^{a s}^p^ecifⁱ^{c dis}^r^eg^{ard f}^o^{r all}
^applican^ts^{. In}^th^es^{e cas}^es^{, th}^{e re}^p^o^{rted in}^com^e^s^t^an^{dard m}^o^s^t^lik^ely^accouⁿ^t^s^f^o^{r u}ⁿⁱ^v^e^rs^ally
^{applied dis}^r^eg^ards^{, an}^{d m}^o^{re clos}^ely^ref^l^ects^th^e^effectiveⁱⁿ^co^m^e^lev^e^l.
As seen in the first row, last column of Table 1, 12 states had an upper income
eligibility threshold below 200% FPL, 26 states had an upper income eligibility
threshold of exactly 200% FPL, and 13 states had an upper income eligibility
threshold above 200% FPL.
Eligibility thresholds among separate state programs tend to be higher than
among Medicaid expansions. States with combination programs use their Medicaid
expansion program for lower income children and one or more separate state
programs for children with higher income levels.

In determining financial eligibility for SCHIP, states may elect to disregard
some portion of income and/or deduct certain expenses when calculating a family’s
net income, which is then compared against the income thresholds reported above.
With these methods, states extend eligibility beyond the stated financial standards.
For example, many states disregard some amount of earned income and/or deduct
specified amounts of child support payments. In other cases, states may disregard all
income within a specified range. For example, New Jersey has expanded eligibility
to 350% FPL — the highest of any state — in one of its separate state programs by
disregarding all income between 200% FPL and 350% FPL. As shown in Table 1,

46 states use basic income disregards.⁴

States may also take resources, or assets, into account in determining financial
eligibility for SCHIP. States determine what items constitute countable assets and
how those countable items are valued. Generally, resources such as homes and
wedding rings have not been counted, regardless of their value, while cars, savings
accounts and savings bonds, for example, have generally been counted. As shown
in Table 1, only two states (one under its Medicaid expansion program and one in
its separate state program) use an asset test.
Other Eligibility and Enrollment Characteristics
Presumptive eligibility and continuous eligibility (see Table 1) are policies
designed to assist children in getting and staying enrolled in Medicaid and SCHIP.
Under presumptive eligibility, states are allowed to enroll children whose family
income and resources appear to be below the applicable financial standards until a
formal eligibility determination is completed. Nine states offer presumptive
eligibility. Continuous eligibility allows a child to remain enrolled for a set period
of time regardless of whether the child’s circumstances change (e.g., the family’s
income rises above the eligibility threshold), thus making it easier for a child to stay
enrolled. Thirty-six states offer continuous eligibility, the majority of them for a 12
month-period.
Capping enrollment is one means states can use to control program spending.
While an individual entitlement exists for children enrolled in Medicaid expansions,
there is no such entitlement under separate state programs. States with separate
SCHIP programs can cap enrollment by receiving Centers for Medicare and Medicaid
Services (CMS) approval to amend their state SCHIP plans to include such a cap.
Two states (Montana and Utah) have specific enrollment caps written into their state
plans, and another state (Florida) has language in its state plan allowing the state to
cap enrollment at any time without additional CMS approval.
Under Medicaid, states must provide coverage to pregnant women of any age
living in families with income at or below 133% of FPL. States also have the option
to extend such coverage up to 185% of FPL.

⁴ States are classified as using a basic income disregard if they (1) disregard some amount
of earnings, (2) allow a deduction for child care expenses, and/or (3) disregard all income
between a specified range of the federal poverty level. See Appendix 1 for further details.

While SCHIP does not include pregnancy status among its eligibility criteria,
and as a rule does not cover persons over age 18, there are three circumstances under
which pregnant women over 18 could be covered in separate SCHIP programs. First,
the “family coverage option” allows states to provide coverage under a group health
plan that may include maternity care. States may cover the entire family including
parents if the purchase of such family coverage is cost effective when compared to
the cost of covering only the targeted low-income children in the family, and would
not substitute for other health insurance. There are no official data that identify for
which states this circumstance applies. Second, states can apply for waivers of
program rules to extend coverage to adults. As of June, 2003, 10 states had Section
1115 waivers that expanded SCHIP coverage to include one or more categories of
adults with children, typically parents of Medicaid/SCHIP children, caretaker
relatives, legal guardians, and/or pregnant women. Finally, in a rule published in
October of 2002, the definition of a “child” for SCHIP purposes was changed such
that states may consider an unborn child to be a targeted low-income child if all other
applicable eligibility requirements are met. This change allowed states to extend
SCHIP coverage to pregnant women of any age who meet all financial eligibility
requirements of the program. Three states (Illinois, Michigan and Rhode Island)
provide prenatal care to unborn children in their separate SCHIP programs.
State by state detail on income disregards, asset tests, presumptive and
continuous eligibility, enrollment caps and waiting lists, and prenatal coverage for
unborn children can be found in Appendices 2 and 4.
Benefit Packages
As noted above, when designing their SCHIP program, states may expand their
current Medicaid program, create a new “separate state” insurance program, or devise
a combination of both approaches.
States that choose to cover targeted low-income children under Medicaid must
provide the full range of mandatory Medicaid benefits, as well as all optional services
specified in their state Medicaid plans.
States that create separate state programs choose any of three benefit options:
(1) a benchmark benefit package, (2) benchmark equivalent coverage, or (3) any
other health benefits plan that the Secretary of Health and Human Services
determines will provide appropriate coverage to the targeted population of uninsured
children (referred to as a Secretary approved benefits plan). In addition, for Florida,
New York, and Pennsylvania, specific programs already in existence when the law
establishing SCHIP was enacted were designated as meeting the minimum benefit
requirements under SCHIP. These grandfathered programs are called existing
comprehensive state-based programs.
A benchmark benefit package is one of the following three plans: (1) the
standard Blue Cross/Blue Shield preferred provider option plan offered under the
Federal Employees Health Benefits Program (FEHBP), (2) the health coverage that
is offered and generally available to state employees in the state involved, and (3) the

health coverage that is offered by a health maintenance organization (HMO) with the
largest commercial (non-Medicaid) enrollment in the state involved.
Benchmark equivalent coverage is defined as a package of benefits that has the
same actuarial value as one of the benchmark benefit packages. A state choosing to
provide benchmark equivalent coverage must cover each of the benefits in the “basic
benefits category.” The benefits in the basic benefits category are inpatient and
outpatient hospital services, physicians’ surgical and medical services, lab and x-ray
services, and well-baby and well-child care, including age-appropriate
immunizations. Benchmark equivalent coverage must also include at least 75% of
the actuarial value of coverage under the benchmark plan for each of the benefits in
the “additional service category.” These additional services include prescription
drugs, mental health services, vision services, and hearing services. States are
encouraged to cover other categories of service not listed above. Abortions may not
be covered, except in the case of a pregnancy resulting from rape or incest, or when
an abortion is necessary to save the mother’s life.
Six categories of Secretary approved coverage are defined in regulation.⁵ These
include coverage that (a) is the same as the coverage provided to children under the
state Medicaid plan; (b) is the same as the coverage provided to children under a
comprehensive Medicaid Section 1115 waiver; (c) either includes the full Early and
Periodic Screening, Diagnosis, and Treatment (EPSDT) benefit⁶ or that the state has
extended to the entire Medicaid population in the state; (d) includes benchmark
health benefits coverage plus any additional coverage; (e) is the same as the coverage
provided under existing comprehensive state-based programs in Florida,
Pennsylvania, or New York; or (f) is substantially equivalent to or greater than
coverage under a benchmark health benefits plan, determined via a benefit-by-benefit
comparison demonstrating that coverage for each benefit meets or exceeds the
corresponding coverage under the benchmark health benefits plan. Secretary-
approved benefit plans are not limited to these six categories, as long as the coverage
provided is determined to be appropriate for the target population.
Table 2 summarizes the types of benefit packages used by the 44 separate state
programs that existed as of June, 2003.

⁵ Department of Health and Human Services, “State Child Health; Revisions to the
Regulations Implementing the State Children’s Health Insurance Program,” 66 Federal
Register, 33810, June 25, 2001.
⁶ The EPSDT program provides screening and preventive care to nearly all groups of
Medicaid beneficiaries under 21 years old, as well as services necessary to correct a health
problem identified through screening,

Table 2. Benefits Packages in Separate State Programs,
as of June 30, 2003
^Existⁱ^ng
^B^e^nchm^a^r^k^{Secretary approved:}^com^p^rehensⁱ^ve
^B^e^nchm^a^r^k^:¹²^eq^uⁱ^val^en^{t: 11}¹⁸^st^a^t^e^ba^se^d:³
^FE^HB^P^:²^FE^HB^P^:²^B^e^nc^hm^a^r^{k p}^l^us^Flo^r^id^a
^{State Em}^ploy^{ee: 6}^{State em}^ploy^{ee: 8}^ad^d^itioⁿ^a^{l: 4}^New^Yo^rk
^L^a^rg^{est HMO: 4}^L^a^rg^{est HMO: 0}^Co^m^p^r^e^he^nsi^v^e^P^e^nnsy^l^vaⁿⁱ^a
^Eq^uⁱ^v^a^len^t^to^{all th}^r^ee:^Medi^cai^{d S}^ectⁱ^oⁿ¹¹¹⁵
¹^w^a^iv^er^{: 3}
^Sam^e^as^{Medicaid: 9}
^{State em}^ploy^{ee: 1}
^Oth^e^{r: 1}
^So^urce^{: See A}^p^p^eⁿ^d^ix¹
Cost Sharing
Federal law permits states to require cost-sharing⁷ for some beneficiaries and
some services under SCHIP. Cost-sharing policies and limits are different for
Medicaid expansions versus separate state programs as described below. A total of
38 states require some form of cost-sharing in either a Medicaid expansion, separate
state program or both (see Appendix 3 for details).
Cost-Sharing Under Medicaid Expansions
States that choose to implement SCHIP as a Medicaid expansion must follow
the cost-sharing rules of the Medicaid program, which prohibits cost-sharing for
children under 18. Nominal cost-sharing is allowed for persons 18 years of age and
older. However, if a state has a Section 1115 waiver that allows cost-sharing for
children enrolled in its Medicaid program, the state may also impose cost-sharing for
children enrolled in a Medicaid expansion under SCHIP.
Six states — Arkansas, Missouri, New Mexico, Ohio, Rhode Island, and
Wisconsin — have Section 1115 waiver programs that include cost-sharing for
children in Medicaid expansions. Five of these states are Medicaid expansion-only
states; i.e., they do not also have a separate SCHIP program. Rhode Island is a
combination state for which cost-sharing applies to children in its Medicaid
expansion under a Section 1115 waiver and in its separate state program for unborn
children (also under Section 1115 waiver authority).

⁷ Three forms of cost-sharing for beneficiaries are most common. A premium, usually paid
on a monthly basis, represents the price beneficiaries must pay for insurance coverage,
regardless of whether services are actually received. A copayment is an item- or service-
specific fee (e.g., $10 for an office visit) that is paid at the time that item or service is
rendered. A deductible, typically applied on an annual basis (e.g., a $250 deductible per
year), is the amount beneficiaries must incur before the insurance begins to cover the
subsequent costs of care. Premiums do not count toward a deductible requirement.

These six states fall into two cost-sharing groups. Three of these states
(Arkansas, Missouri and New Mexico) require more than nominal co-payments for
selected services and do not require any form of premium payments or annual fees.
Two of the remaining states (Rhode Island and Wisconsin) require monthly
premiums only with no co-payments for services, and one state (Ohio)⁸ has approval
to implement an annual fee only.
Cost-Sharing Under Separate State Programs
If a state implements SCHIP through a separate state program, premiums or
enrollment fees for program participation may be imposed, but the maximum
allowable amount is dependent on family income. For all families with incomes
under 150% FPL and enrolled in separate state programs, premiums may not exceed
the amounts set forth in federal Medicaid regulations. Additionally, these families
may be charged service-related cost-sharing, but such cost-sharing is limited to (1)
nominal amounts defined in federal Medicaid regulations for the subgroup with
income below 100% FPL, and (2) slightly higher amounts defined in SCHIP
regulations for families with income between 101-150% FPL. For a family with
income above 150% FPL, cost-sharing may be imposed in any amount, provided that
cost-sharing for higher income children is not less than cost-sharing for lower income
children.
The total annual aggregate cost-sharing (including premiums, deductibles,
copayments and any other charges) for all children in any SCHIP family may not
exceed 5% of total family income for the year. In addition, states must inform
families of these limits and provide a mechanism for families to stop paying once the
cost-sharing limits have been reached.
Most separate state programs require cost-sharing in the form of either
premiums, copayments or both. Some states charge a quarterly or annual enrollment
fee instead of a monthly premium. Table 3 shows cost-sharing patterns among the
44 separate state programs in the 36 states with such programs. Most of these
programs have a sliding scale for cost sharing; i.e., the amount paid depends on
family income. Eight programs require co-pays, but no premiums. Sixteen programs
require premiums, but no co-pays. Finally, 16 programs require both premiums and
co-pays. While states have the option to require deductibles, only one state does so
(data not shown).⁹

⁸ Ohio has not implemented its Section 1115 waiver.
⁹ North Dakota requires enrollees to pay a $50 deductible for the first day of each inpatient
hospital admission in a general hospital or a psychiatric or substance abuse inpatient facility.

Table 3. Cost-Sharing Patterns in Separate State Programs,
as of July 31, 2003
^Fl^{at s}^c^al^e^a^Sliding^sca^l^e^b
^p^r^ogram^s^p^r^ogram^s^T^o^tal^p^r^ogram^s
^Co^{st sha}^r^ing^re^q^u^ire^d¹⁴²⁶⁴⁰
^C^o^-^p^ay^{, n}^o^prem^iu^m⁴⁴⁸
^P^r^em^iu^m^,ⁿ^o^co-^p^ay⁷⁹¹⁶
^P^r^em^iu^m^an^{d co-}^p^ay³¹³¹⁶
^Co^{st sha}^r^ing^no^{t re}^q^u^ire^d^—^—⁴
^Sources^:^S^{ee A}^ppen^dⁱ^x^1.
^N^o^t^e^:^T^hⁱ^s^t^a^bl^{e s}^h^ow^s^cos^t^-^s^h^a^riⁿ^g^pat^t^e^rn^s^am^on^g^t^h^{e 44 s}^e^parat^e^s^t^at^{e prog}^ram^sⁱⁿ^{36 s}^t^at^es^.
^a^{Flat s}^{cale prog}^ram^s^{are th}^os^{e f}^o^{r w}^h^ich^cos^t^-^s^h^a^rin^g^doesⁿ^o^{t v}^a^ry^acros^sⁱⁿ^com^e^{or ag}^{e g}^r^ou^ps^.
^b^A^ll^s^t^ates^ex^{cept f}^o^{r on}^{e bas}^e^th^{eir s}^lidin^g^s^cales^oⁿ^f^a^m^ilyⁱⁿ^co^m^e^{. Geo}^r^gⁱ^{a b}^a^{ses its slid}ⁱⁿ^g^scale
^oⁿ^th^{e ch}^ild^’^s^ag^e.^Iⁿ^ad^d^itioⁿ^,^A^l^ask^a^an^d^Ken^t^u^c^k^y^im^p^o^s^{e co}^st-^s^h^a^rⁱⁿ^g^oⁿ¹⁸^-^y^ear^o^l^d^s^oⁿ^ly^.
^See^{Appendix 3}^a^{nd 4}^f^o^{r f}^u^rt^h^e^{r det}^aⁱ^l^s^.
Table 4 shows premiums/enrollment fees and selected co-payment amounts in
separate state programs. The “high” and “low” columns show the highest and lowest
charges among all flat-scale programs only and among all sliding scale programs
only. The amounts charged by sliding-scale programs for a given service tend to
reflect a wider range of values than the amounts charged by flat-scale programs. This
result is largely because charges for sliding scale programs vary across multiple
income bands. Among the 24 programs that charge co-pays (see Table 3), 20 charge
co-pays for prescription drugs, 18 charge for office visits, six charge for inpatient
services, 15 charge for emergency use of an emergency room, and 22 charge for non-
emergency use of an emergency room. The specific amounts charged under each
program can be seen in Appendices 3 and 4.

Table 4. Premiums/Enrollment Fees and Selected Co-Payment
Amounts in Separate State Programs, as of July 31, 2003
^{14 fl}^{at s}^c^al^e^a^{26 s}^lⁱ^dⁱⁿ^{g s}^c^al^e^b
^p^r^ogram^s^p^r^ogram^s
^To^t^a^l^Nu^m^b^{er o}^f^c^Nu^m^b^{er o}^f^c
^p^r^ogram^s^prog^ram^s^L^o^w^Hig^h^prog^ram^s^L^o^w^Hig^h
^Pr^emium/enr^o^{llment fees}
^N^o^premⁱ^u^m^or
^en^ro^llm^en^{t f}^e^e⁴^—^—⁴^—^—⁸
^M^o^nt^hl^y^p^r^e^mⁱ^u^m^s
^requⁱ^r^ed¹⁰^$5^$50¹⁶^$4^$135²⁶
^Qu^ar^ter^l^y^en^r^o^llm^en^{t f}^e^e
^requⁱ^r^ed⁰^—^—²^$10^$50²
^A^nnua^l^eⁿ^r^o^l^l^m^eⁿ^t^fe^e
^requⁱ^r^ed⁰^—^—⁴^$35^$150⁴
^C^o^-paym^e^nt^s
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^In^patⁱ^eⁿ^t^s^e^rvⁱ^ces¹^$25^$25⁵^$⁵^$100⁶
^Em^erg^eⁿ^c^y^room⁶^$²^$10⁹^$³^$50¹⁵
^N^o^n-e^m^e^r^ge^nc^y^use^o^f
^ER⁷^$²^$25¹⁵^$3^$50²²
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^{a. Flat s}^{cale prog}^ram^s^{are th}^os^{e f}^o^{r w}^h^ich^cos^t^-^s^h^a^rin^g^doesⁿ^o^{t v}^a^ry^acros^sⁱⁿ^com^e^{or ag}^{e g}^r^ou^ps^.
^{b. A}^{ll s}^t^ates^ex^{cept f}^o^{r on}^{e bas}^e^th^eir^s^lidin^g^s^cales^oⁿ^f^a^m^ilyⁱⁿ^co^m^e^{. Geo}^r^gⁱ^{a b}^a^ses^its^slidⁱⁿ^g^scale
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ⁱⁿ^th^{e lo}^w^e^{st in}^co^m^e^co^v^e^r^a^g^e^g^r^o^u^p^s^.
Substitution of SCHIP for Private Health Insurance
Finally, states that establish SCHIP programs must ensure that SCHIP does not
substitute for coverage under group health plans, a phenomenon known as “crowd
out.”¹⁰ The primary method for preventing crowd-out is requiring a waiting period,
that is, specified lengths of time for which applicants must be uninsured, prior to
enrollment in SCHIP. Waiting periods are only permitted in Medicaid expansions
under a Section 1115 waiver. As seen in the third to last column of Appendix 2, 30
states require a waiting period, ranging from one to six months

¹⁰ For further information, see CRS Report RL30657 Limiting and Measuring the
Substitution of the State Children’s Health Insurance Program (SCHIP) for Private Health
Insurance, by Debra Cohan.

Requiring cost-sharing under SCHIP may also serve as a crowd-out prevention
measure, by discouraging applicants from viewing SCHIP as more attractive than
employer-sponsored insurance for which cost-sharing is common. As noted above,

38 states require cost-sharing.

Finally, premium subsidy programs can encourage use of private instead of
public insurance for low-income children whose parents have access to employer-
sponsored insurance (ESI) but cannot afford their share of the premium.¹¹ Under
separate state programs, states that provide premium assistance for employer-
sponsored insurance to the families of targeted low-income children must require: (1)
with some exceptions, a waiting-period of six to twelve months without group health
plan coverage before coverage through the premium assistance program begins; (2)
identify a reasonable minimum employer contribution level and provide justification
for that level; and (3) a premium subsidy that does not exceed the payment the state
would otherwise make on the child’s behalf. As shown in Appendix 2, six states
provide access to ESI under at least one of their separate state programs (as noted
above, some states have multiple separate SCHIP programs). Two of these states have
Section 1115 waivers; one waives the minimum employer contribution, and the other
requires a 50% employer contribution. The remaining states require employer
contributions ranging from 30 to 50%.
States may also provide premium assistance for employer-sponsored health
insurance through Medicaid expansions. Under Medicaid, states may pay a
beneficiary’s share of the costs for group health coverage for any Medicaid enrollee
for whom employer-based coverage is available and that coverage is both
comprehensive and cost-effective for the state. An individual’s enrollment in an
employer plan is cost-effective if paying the premiums, deductibles, coinsurance and
other cost-sharing obligations of the employer plan is less expensive than the state’s
expected cost of directly providing Medicaid-covered services. Two states offer ESI
through their Medicaid expansions using Section 1115 waiver authority; one requires
a minimum employer contribution of 40%.
Section 1115 Waivers
States that want to make changes to their SCHIP programs that go beyond what
the law will allow may do so through what is called a Section 1115 waiver (named for
the section of the Social Security Act that defines the circumstances under which such
waivers may be granted). The Secretary of Health and Human Services may waive
certain statutory requirements for conducting research and demonstration projects
under SCHIP that allow states to adapt their programs to specific needs.

¹¹ Unless the state has a waiver specifying otherwise, states must insure that the benefit
packages and cost-sharing obligations under employer-sponsored insurance programs meet
the requirements in SCHIP statute. If the ESI benefit package falls short of the statute’s
requirements, states must provide “wrap-around” services to bridge any gaps between the
ESI benefit package and the SCHIP benefits package offered by the state.

On August 4, 2001, the Bush Administration announced the Health Insurance
Flexibility and Accountability (HIFA) Demonstration Initiative. Using Section 1115
waiver authority, this initiative is designed to encourage states to extend Medicaid and
SCHIP to the uninsured, with a particular emphasis on statewide approaches that
maximize private health insurance coverage options and target populations with
income below 200% FPL.
As of July, 2003, CMS had approved 14 SCHIP Section 1115 waivers in 13
states.¹² Eight of the 14 approved waivers are HIFA demonstrations in Arizona,
California, Colorado, Illinois, New Jersey, New Mexico, New York and Oregon. In
10 of the 13 states with approved Section 1115 waivers (excluding Maryland, New
York, and Ohio), SCHIP coverage is expanded to include one or more categories of
adults¹³ with children, typically parents of Medicaid/SCHIP children, caretaker
relatives, legal guardians, and/or pregnant women. Three states (Arizona, New
Mexico and Oregon) also cover childless adults under their HIFA demonstrations.
In addition to expanding coverage to new populations under waivers, some states
have used this authority for other purposes. Rhode Island has been granted approval
to use redistributed SCHIP funds to finance coverage of adults with children in its
waiver program. Through HIFA, New Jersey will offer the same (separate SCHIP
program) benefit package to adults covered under its SCHIP and Medicaid waiver
demonstrations. Using Section 1115 waiver authority, both Maryland and New
Mexico require a six-month period of no insurance prior to enrollment under their
waivers.¹⁴ New Mexico has also modified its cost-sharing rules for targeted low-
income children under its Medicaid program. New York’s HIFA demonstration
provided temporary disaster relief in New York City due to the events of September
11, 2001. Finally, Ohio received approval to implement an annual enrollment fee and
to give 12 months of continuous eligibility for certain targeted low-income children
in its Medicaid program.¹⁵
States can also modify their SCHIP programs using a Medicaid 1115 waiver. In
addition to the states identified above, four other states (Arkansas, Hawaii, Missouri,
and Tennessee) with Medicaid expansions only used waiver authority to expand an
existing comprehensive Medicaid 1115 demonstration program. Other modifications
affecting the Medicaid expansions in these states included, for example, establishing

¹² The 13 states are AZ, CA, CO, IL, MD, MN, NJ, NM, NY, OH, OR, RI, and WI. NM has
two approved SCHIP Section 1115 waivers. The remaining states have one waiver each.
¹³ States have the option to purchase family coverage under a group health plan that may
cover adults as long as it is cost-effective to do so (relative to the amount paid for
comparable coverage for the children only), and it must not substitute for health insurance
that would otherwise be provided to the children. For states seeking greater flexibility both
in selecting which adults to cover and in the benefit package offered to those adults, a
waiver is required.
¹⁴ In general, for Medicaid expansions under SCHIP, all Medicaid rules apply. Thus, when
states with SCHIP Medicaid expansions want to implement other rules (e.g., establish
waiting periods before enrollment, implement enrollment fees, etc.), a waiver is required.
¹⁵ Due to a variety of budget and resource constraints, in May 2002, OH decided not to
pursue implementation of its waiver.

a six-month waiting period prior to enrollment, higher cost-sharing requirements that
exceed otherwise allowable limits, and authority to implement enrollment caps as
necessary.
Appendices. State by State Program Characteristics
Appendix 1 describes the methodology employed throughout this report.
Appendices 2 and 3 are state-by-state matrices of selected program characteristics
and selected cost-sharing amounts, respectively. Appendix 4 consists of 51 tables
that provide an overview of general SCHIP program characteristics for each of the 50
states and the District of Columbia.
As of October 1, 2002, all children under age 19 in families with income up to

100% FPL must be covered by Medicaid and thus cannot be enrolled in SCHIP.

Therefore, there is no Medicaid expansion information presented for the four states¹⁶
that had such programs prior to October 1, 2002 solely to cover such children.
For more information about SCHIP, see CRS Report RL30642, The State
Children’s Health Insurance Program: Eligibility, Enrollment and Program Funding,
by Evelyne Baumrucker, and CRS Report RL30473, State Children’s Health
Insurance Program: A Brief Overview, by Elicia Herz and Peter Kraut.

¹⁶ AL, MS, TN, and TX.

Appendix 1. Methodology
The main source of data presented in this report is a CRS database that is based
primarily on information contained in official SCHIP state plans and accompanying
documentation, including all amendments approved by CMS as of June 30, 2003.
SCHIP state plans do not contain detailed information on certain program
characteristics, in particular for Section 1115 waivers and for Medicaid expansion
programs. In addition to the CRS database, other sources of data used in this report
include the following:
^!Information on SCHIP Section 1115 waivers is from the Centers for
Medicare and Medicaid Services, Section 1115 Demonstrations: State
Profiles, July 25, 2003, at [http://www.cms.hhs.gov/schip/
1115waiv.pdf], as well as CMS/State Terms and Conditions and/or
Operational Protocol documents. In some cases, we also contacted
CMS and state officials to clarify or expand on information contained
in these documents.
^!For Medicaid expansion programs, information on income eligibility
thresholds (lower and upper bounds) is taken from documentation
accompanying SCHIP state plans, SCHIP annual evaluation reports,
and CRS Report RL30642, The State Children’s Health Insurance
Program: Eligibility, Enrollment and Program Funding, by Evelyne
Baumrucker.
^!Data as of April, 2003, on asset tests, continuous and presumptive
eligibility, waiting periods, and cost-sharing for Medicaid expansion
programs are taken from Donna Cohen Ross and Laura Cox,
Preserving Recent Progress On Health Coverage For Children and
Families: New Tensions Emerge A 50 State Update On Eligibility,
Enrollment, Renewal And Cost-Sharing Practices In Medicaid and
SCHIP, Center on Budget and Policy Priorities, (prepared for the
Kaiser Commission on Medicaid and the Uninsured), July 2003.
^!A CRS survey of states on selected program characteristics for
separate SCHIP programs as of December 31, 2002, is the basis for
the “presumptive eligibility” information for such programs.
^!States are not required to provide detailed information on income
counting methods in their state SCHIP plans. Data on “basic income
disregards” for Medicaid expansions and separate SCHIP programs
are taken from two surveys: (1) a CRS survey of selected program
characteristics for separate SCHIP programs as of December 31,
2002, and (2) a survey conducted under contract to CRS by the
George Washington University of selected program characteristics for
Medicaid expansions (and eligibility rules for other groups of
Medicaid children) as of December 31, 2002. Throughout this report,
a “yes” entry for the “basic income disregards” field means that the
state: (a) disregards some amount of earnings, or (2) allows a
deduction for child-care expenses, or (3) disregards all income

between a specified range of the federal poverty level (e.g., in its
separate SCHIP program, New Jersey disregards all income between
200-350% FPL). Coding of “basic income disregards” among
Medicaid expansion programs requires additional explanation.
SCHIP law defines a SCHIP eligible as a targeted low-income child
under the age of 19 with no health insurance, and who would not
have been eligible for Medicaid under the rules in effect on March 31,
1997. Under Medicaid, states may cover targeted low-income
children in one or more of the following ways: (1) by establishing a
new optional eligibility group for such children as authorized in
SCHIP law, (2) by liberalizing the financial rules for any of several
existing Medicaid eligibility categories (e.g., the poverty-related
groups) using Section 1902(r)(2) authority, and/or (3) by liberalizing
the income standards or methodologies applicable to family coverage
under Section 1931. Many states have chosen to cover targeted low-
income children under existing Medicaid eligibility pathways,
especially the poverty-related groups, rather than by establishing the
optional coverage group identified in SCHIP law. On the CRS-
sponsored Medicaid eligibility survey conducted by George
Washington University, there was no field indicating which of these
options a state used to create its SCHIP Medicaid expansion group.
The “basic income disregards” field was coded as “yes” if the criteria
described above were met for any of the relevant groups.
^!There are inconsistencies in state SCHIP plans in how states report
lower income boundaries that apply to different age groups under
SCHIP. The lower income boundaries shown in this report reflect the
upper income boundary applicable to the next adjacent age or income
group. For example, children up to six years of age in families with
income up to 133% of the federal poverty level (FPL) must be
covered in the regular Medicaid program. For a state implementing
a separate SCHIP program for the same age group, the lower income
boundary shown in this report would equal 133% FPL.

CRS-16
Appendix 2. Selected SCHIP Program Characteristics by State, as of December 31, 2002 through July 31, 2003
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^X²⁰⁰^no^no^y^e^sⁿ^o¹²ⁿ^oⁿ^oⁿ^o^S^ecret^ary^A^ppr^ov^e^d^m^a^r^k^plus⁰ⁿ^o^N^A
^://wiki^a^dditiona^l
^h^ttp^MX^P^:^N^A^S^ecret^ary^B^e^nc^h-^MX^P^:⁰
^X²⁰⁰^no^no^y^e^sⁿ^o⁰^no^SSP^{: no}^no^A^ppr^ov^e^d^m^a^r^k^plus^SSP^{: 6}^no^N^A
^a^dditiona^l
^X²⁰⁰^no^no^y^e^sⁿ^o¹²ⁿ^o^N^Aⁿ^o^N^A^N^A⁰^no^N^A
^X²⁰⁰^no^no^MX^P^:^y^e^s^SSP^:no^no¹²^no^MX^P^:^N^A^SSP^{: no}^no^S^ecret^ary^A^ppr^ov^e^d^Sa^m^e^a^s^M^e^dⁱ^cai^d^MX^P^:⁰^SSP^{: 3}^no^N^A
^X³⁰⁰^no^MX^P^:^y^e^s^SSP^{: no}^ye^sⁿ^o^MX^P^:⁶^SSP^{: 12}^no^MX^P^:^N^A^SSP^{: no}^no^S^ecret^ary^A^ppr^ov^e^d^Sa^m^e^a^s^M^e^dⁱ^cai^d^c^MX^P^:⁶^SSP^{: 6}^MX^P^:^no^SSP^{: y}^e^s^30%
^La^r^g^e^s^t
^HM^O,
^MX^P^:^y^e^s^MX^P^:^N^A^Bn^ch^m^a^rk^;^Co^m^p^re-^he^ns^iv^e^MX^P^:^no^SSP^:
^X²⁰⁰^no^no^no^no⁰^SSP^:^SSP^{: no}^no^S^ecret^ary^M^e^dⁱ^cai^d⁰^ye^s^/ⁿ^o^50%
^ye^s^/ⁿ^o^A^ppr^ov^e^d^Se^c^tion
¹¹¹⁵
^Waⁱ^v^e^r
^X²⁰⁰^no^no^y^e^sⁿ^o^MX^P^:⁰^SSP^{: 12}^MX^P^:^no^SSP^{: y}^e^s^MX^P^:^N^A^SSP^{: y}^e^s^no^B^e^nc^hm^a^r^k^Sta^t^e^Em^ploy^e^e^MX^P^:⁰^SSP^{: 6}^no^N^A
^X²⁸⁰^y^e^sⁿ^o^y^e^s^no⁰ⁿ^o^N^Aⁿ^o^N^A^N^A⁰^no^N^A

CRS-18
^W^a^itin^g^Miⁿ^.
^p^eri^od^em^p^l^oy^er
^W^aⁱ^v^{er to}^Waⁱ^v^e^r^En^r^o^ll-^to^S^ubsⁱ^d^y^p^remⁱ^u^m
^U^ppe^r^{cover g}^r^ou^p^s^affectiⁿ^g^P^renat^al^meⁿ^t^p^reven^t^f^o^{r pri}^vat^e^sh^are
ⁱⁿ^c^o^m^e^not^ot^her^Ba^sⁱ^c^C^o^ntⁱ^nuous^P^r^e^s^um^p-^{care for}^cap^or^crow^d^-^or^req^uⁱ^red
^MX^P^SSP^Com^-^th^resh^o^l^d^oth^erwⁱ^s^e^SC^H^I^Pⁱⁿ^c^o^m^e^Asset^e^ligib^ility^tiv^e^unborⁿ^w^a^itin^g^out^em^p^l^oy^er^f^o^r^s^ubsⁱ^d^y
^onl^y^Onl^y^bi^natⁱ^on^(%^FPL)^e^ligib^le^provi^si^ons^dⁱ^sreg^ard^tests^(m^oⁿ^th^s)^e^ligib^ility^chⁱ^l^d^ren^list^T^yp^e^O^p^t^ioⁿ^(m^o^s^.)^coverag^e^(%⁾
^B^e^nc^h-^d^d
^X²⁰⁰^no^no^y^e^sⁿ^o¹²ⁿ^o^d^no^no^S^ecret^ary^A^ppr^ov^e^d^m^a^r^k^plus⁰ⁿ^o^NA
^a^dditiona^l
^Co^m^p^re-
^he^ns^iv^e
^X³⁰⁰^no^y^e^s^y^e^s^no⁰^y^e^s^N^A^no^M^e^dⁱ^cai^d^Se^c^tion^NA⁶ⁿ^o^N^A
¹¹¹⁵
^Waⁱ^v^e^r
^B^e^nc^hm^a^r^k^Sta^t^e³ⁿ^o^N^A
ⁱ^{ki/CRS-RL32389}^X¹⁵⁰^no^no^y^e^sⁿ^o¹²ⁿ^oⁿ^o^y^e^s^Equiv^a^le^nt^Em^ploy^e^e
^g/w^X¹⁸⁵^no^no^y^e^sⁿ^o⁶^y^e^s^N^Aⁿ^o^N^A^N^A⁰^no^N^A
^s^.or^S^ecret^ary^Sa^m^e^a^s
^le^ak^X²⁰⁰^no^no^no^no¹²^no^no^no^A^ppr^ov^e^d^M^e^dⁱ^cai^d⁶ⁿ^o^N^A
^MX^P^:^y^e^s^MX^P^:^N^A^no^B^e^nc^hm^a^r^k^FEH^B^P^MX^P^:⁰^no^N^A
^://wiki^X³⁰⁰^no^no^y^e^sⁿ^o⁰^SSP^{: no}^SSP^{: no}^Equiv^a^le^nt^SSP^{: 6}
^h^ttp^MX^P^:^y^e^s^MX^P^:^y^e^s^FEH^B^P
^X³⁵⁰^y^e^sⁿ^o^SSP^:^no⁰^SSP^:^MX^P^:^N^A^SSP^{: no}^no^B^e^nc^hm^a^r^k^an^d^La^r^g^e^s^t^MX^P^:⁰^SSP^{: 6}^MX^P^:^no^SSP^{: y}^e^s^50%
^ye^s^/ⁿ^o^ye^s^/ⁿ^o^HM^O
^Co^m^p^re-
^he^ns^iv^e
^X²³⁵^y^e^s^y^e^s^y^e^sⁿ^o¹²^y^e^s^N^A^no^M^e^dⁱ^cai^d^Se^c^tion^NA⁰ⁿ^o^N^A
¹¹¹⁵
^Waⁱ^v^e^r
^Ex^isting
^X²⁵⁰^no^e^no^e^MX^P^:^y^e^s^SSP^{: no}^no^MX^P^:¹²^SSP^{: 0}^MX^P^:^no^SSP^{: y}^e^s^MX^P^:^N^A^SSP^{: no}^no^Co^m^p^re-^he^ns^iv^e^NA⁰ⁿ^o^N^A
^st^at^e-b^a^sed
^X²⁰⁰^no^no^y^e^sⁿ^o¹²ⁿ^oⁿ^oⁿ^o^B^eⁿ^c^h^m^a^r^k^Sta^t^e^Em^ploy^e^e⁰ⁿ^o^N^A
^X¹⁴⁰^no^no^y^e^sⁿ^o^MX^P^:⁰^SSP^{: 12}^no^MX^P^:^N^A^SSP^{: no}^no^B^e^nc^hm^a^r^k^Equiv^a^le^nt^Sta^t^e^Em^ploy^e^e^MX^P^:⁰^SSP^{: 6}^no^N^A
^X²⁰⁰^no^y^e^s^f^y^e^sⁿ^o⁰ⁿ^o^NAⁿ^o^NA^NA⁰ⁿ^o^N^A
^X¹⁸⁵^no^no^y^e^sⁿ^o⁰^no^N^A^no^N^A^N^A⁰ⁿ^o^N^A

CRS-19
^W^a^itin^g^Miⁿ^.
^p^eri^od^em^p^l^oy^er
^W^aⁱ^v^{er to}^Waⁱ^v^e^r^En^r^o^ll-^to^S^ubsⁱ^d^y^p^remⁱ^u^m
^U^ppe^r^{cover g}^r^ou^p^s^affectiⁿ^g^P^renat^al^meⁿ^t^p^reven^t^f^o^{r pri}^vat^e^sh^are
ⁱⁿ^c^o^m^e^not^ot^her^Ba^sⁱ^c^C^o^ntⁱ^nuous^P^r^e^s^um^p-^{care for}^cap^or^crow^d^-^or^req^uⁱ^red
^MX^P^SSP^Com^-^th^resh^o^l^d^oth^erwⁱ^s^e^SC^H^I^Pⁱⁿ^c^o^m^e^Asset^e^ligib^ility^tiv^e^unborⁿ^w^a^itin^g^out^em^p^l^oy^er^f^o^r^s^ubsⁱ^d^y
^onl^y^Onl^y^bi^natⁱ^on^(%^FPL)^e^ligib^le^provi^si^ons^dⁱ^sreg^ard^tests^(m^oⁿ^th^s)^e^ligib^ility^chⁱ^l^d^ren^list^T^yp^e^O^p^t^ioⁿ^(m^o^s^.)^coverag^e^(%⁾
^Co^m^p^re-
^he^ns^iv^e
^X¹⁸⁵^y^e^s^y^e^s^no^y^e^s⁶^no^no^no^S^ecret^ary^A^ppr^ov^e^d^M^e^dⁱ^cai^d^Se^c^tion⁶^y^e^s^50%
¹¹¹⁵
^Waⁱ^v^e^r
^Ex^isting
^X²⁰⁰^no^no^y^e^sⁿ^o¹²ⁿ^oⁿ^oⁿ^o^Co^m^p^re-^he^ns^iv^e^NA⁰ⁿ^o^N^A
^st^at^e-b^a^sed
ⁱ^{ki/CRS-RL32389}^Co^m^p^re-
^g/w^he^ns^iv^e^Co^m^p^re-
^s^.or^MX^P^:^y^e^s^MX^P^:⁰^MX^P^:^N^A^M^e^dⁱ^cai^d^Se^c^tion^he^ns^iv^e^M^e^dⁱ^cai^d^MX^P^:^y^e^s
^le^ak^X²⁵⁰^y^e^s^SSP^{: no}^ye^sⁿ^o^SSP^{: 12}^no^SSP^{: y}^e^s^no¹¹¹⁵^Se^c^tion⁰^SSP^{: no}^b
^://wiki^Waⁱ^v^e^r^;^S^ecret^ary¹¹¹⁵^Waⁱ^v^e^r
^h^ttp^a^ppr^ov^e^d
^X¹⁵⁰^no^no^y^e^sⁿ^o¹²ⁿ^o^N^Aⁿ^o^N^A^N^A⁰^no^N^A
^X²⁰⁰^no^no^y^e^sⁿ^o⁰^no^MX^P^:^N^A^SSP^{: no}^no^S^ecret^ary^A^ppr^ov^e^d^Sa^m^e^a^s^M^e^dⁱ^cai^d^MX^P^:⁰^SSP^{: 3}^no^N^A
^Co^m^p^re-
^he^ns^iv^e
^X^g^no^y^e^s^y^e^s^no⁰ⁿ^o^N^Aⁿ^o^g^M^e^dⁱ^cai^d^Se^c^tion^NA⁰ⁿ^o^N^A
¹¹¹⁵
^Waⁱ^v^e^r
^X²⁰⁰^no^no^y^e^sⁿ^o¹²ⁿ^oⁿ^oⁿ^o^B^e^nc^hm^a^r^k^Equiv^a^le^nt^Sta^t^e^Em^ploy^e^e³ⁿ^o^N^A
^X²⁰⁰^no^no^no^no¹²^no^no^y^e^s^B^e^nc^hm^a^r^k^Equiv^a^le^nt^Sta^t^e^Em^ploy^e^e³ⁿ^o^N^A
^X³⁰⁰^no^no^y^e^sⁿ^o¹²ⁿ^oⁿ^oⁿ^o^S^ecret^ary^A^ppr^ov^e^d^Sa^m^e^a^s^M^e^dⁱ^cai^d¹ⁿ^o^N^A

CRS-20
^W^a^itin^g^Miⁿ^.
^p^eri^od^em^p^l^oy^er
^W^aⁱ^v^{er to}^Waⁱ^v^e^r^En^r^o^ll-^to^S^ubsⁱ^d^y^p^remⁱ^u^m
^U^ppe^r^{cover g}^r^ou^p^s^affectiⁿ^g^P^renat^al^meⁿ^t^p^reven^t^f^o^{r pri}^vat^e^sh^are
ⁱⁿ^c^o^m^e^not^ot^her^Ba^sⁱ^c^C^o^ntⁱ^nuous^P^r^e^s^um^p-^{care for}^cap^or^crow^d^-^or^req^uⁱ^red
^MX^P^SSP^Com^-^th^resh^o^l^d^oth^erwⁱ^s^e^SC^H^I^Pⁱⁿ^c^o^m^e^Asset^e^ligib^ility^tiv^e^unborⁿ^w^a^itin^g^out^em^p^l^oy^er^f^o^r^s^ubsⁱ^d^y
^onl^y^Onl^y^bi^natⁱ^on^(%^FPL)^e^ligib^le^provi^si^ons^dⁱ^sreg^ard^tests^(m^oⁿ^th^s)^e^ligib^ility^chⁱ^l^d^ren^list^T^yp^e^O^p^t^ioⁿ^(m^o^s^.)^coverag^e^(%⁾
^Sta^t^e
^Em^ploy^e^e^MX^P^:⁰^MX^P^:^N^A
^X²⁰⁰^no^no^MX^P^:^y^e^s^SSP^{: no}^no⁰ⁿ^o^MX^P^:^N^A^SSP^{: no}^no^S^ecret^ary^A^ppr^ov^e^d^a^{nd Sa}^m^e^SSP^{: 6}^ye^s^SSP^{: 40%}
^as
^M^e^dⁱ^cai^d
^X²⁵⁰^no^no^y^e^sⁿ^o¹²ⁿ^oⁿ^oⁿ^o^S^ecret^ary^A^ppr^ov^e^d^Sa^m^e^a^s^M^e^dⁱ^cai^d⁴ⁿ^o^N^A
^X²⁰⁰^no^no^y^e^sⁿ^o¹²ⁿ^oⁿ^oⁿ^o^B^e^nc^hm^a^r^k^Equiv^a^le^nt^Sta^t^e^Em^ploy^e^e⁶ⁿ^o^N^A
ⁱ^{ki/CRS-RL32389}^Co^m^p^re-^he^ns^iv^e
^g/w^X¹⁸⁵^y^e^s^y^e^s^y^e^sⁿ^o⁰^no^N^A^no^M^e^dⁱ^cai^d^N^A³^y^e^s^40%
^s^.or^Se^c^tion
^le^ak¹¹¹⁵
^Waⁱ^v^e^r
^://wiki^X¹⁸⁵^no^no^y^e^sⁿ^o¹²ⁿ^oⁿ^oⁿ^o^S^ecret^ary^O^t^he^r¹^no^N^A
^h^ttp^A^ppr^ov^e^d
¹⁵¹⁸¹⁸^{140 -}³⁵⁰¹⁰¹¹⁴⁶²³⁶⁹³³^s^e^e^T^a^b^l^e³³⁰⁸^0-⁵⁰
^o^r^co^m^b^ina^{tion pr}^og^r^a^m^s^{, if}^the^r^e^is^one^eⁿ^tr^y^{in a}^c^e^{ll, the}^eⁿ^tr^y^a^pplie^s^{to both the}^Me^dic^aⁱ^{d e}^x^pa^ns^{ion (}^M^XP⁾^a^{nd the}^s^e^p^a^rat^e^st^at^{e p}^r^o^g^ram^(S^S^P^).^If^t^h^{ere i}^s^{a d}ⁱ^f^f^e^ren^{ce b}^e^t^w^een^p^r^o^g^ram^s^,^b^o^t^h
^aract^eri^s^tⁱ^c^s^are^rep^o^r^t^e^d^.^F^o^r^st^at^es^wⁱ^t^h^m^o^{re t}^h^an^oⁿ^e^S^S^Pⁱⁿ^w^hⁱ^c^h^t^h^{ere are d}ⁱ^f^f^e^ren^{ces b}^e^t^w^een^S^S^P^p^r^o^g^ram^s^f^o^{r a gi}^ve^{n c}^h^a^r^a^c^t^e^r^istic^{, m}^u^ltiple^aⁿ^sw^e^r^{s a}^r^e^prov^ide^d^{. “}^T^y^p^e^”^a^{nd “}^O^ption”^a^r^e
^l^w^a^y^s^not^a^pplic^a^b^le⁽^N^A⁾^f^o^r^MXP^s^.^For^c^o^m^b^ina^{tion pr}^og^r^a^m^s^{, the}^T^y^pe^a^{nd O}^p^{tion s}^how^{n a}^r^e^f^o^r^the^SSP^s^.^Iⁿ^the^c^ounts^pr^ovⁱ^de^{d in the}^la^{st row}^,^c^o^m^b^ina^{tion sta}^t^e^s^tha^t^ha^v^e^this^c^h^a^r^a^c^t^e^r^isticⁱⁿ
^t^le^a^s^{t one}^of^theⁱ^r^pr^og^r^a^m^s^a^r^e^c^ounte^d^a^s^ha^vⁱ^ng^the^c^h^a^r^a^c^t^e^r^is^tic^{. For}^the^c^o^lumⁿ^s^how^ing^the^“^uppe^r^inc^o^m^e^thr^e^s^hold,”^s^e^e^ta^ble^note^{b on T}^a^ble^{1 in the}^te^x^t^f^o^r^a^dditiona^{l inf}^o^r^m^a^tion.
^s^aⁿ^{1115 w}^a^iv^e^r^pe^nding^tha^t^w^{ould a}^llow^{it to re}^qui^re^a^12-m^{onth w}^a^iting^pe^{riod prior to e}ⁿ^rollm^eⁿ^{t f}^o^{r c}^h^ildre^{n in}^f^a^m^ilie^s^w^{ith inc}^o^m^e^ov^e^r^150%^FP^L^.
^’^Se^c^{tion 1115 H}^I^FA^de^m^ons^tr^a^tion^w^a^iv^e^s^the^mⁱ^nim^u^m^e^m^ploy^e^r^c^ontrⁱ^{bution r}^e^quir^e^m^e^nt.^R^I^doe^s^{not ha}^v^e^a^mⁱ^nim^u^m^req^uⁱ^rem^eⁿ^t^b^ecau^{se su}^ch^{a req}^uⁱ^rem^eⁿ^tⁱ^sⁿ^o^t^ap^p^lⁱ^cab^l^e^f^o^{r M}^X^P^s^,^an^d
^hode^I^s^la^nd’^s^e^m^ploy^e^r^s^pons^or^e^d^ins^u^r^a^nc^e⁽^E^SI⁾^pr^e^m^ium^a^s^sⁱ^s^t^aⁿ^c^e^pr^og^r^a^m^is^done^thr^oug^{h Me}^dic^aⁱ^d.
ⁿ^a^pplic^a^b^le^{, ESI}^m^u^s^t^be^be^nc^hm^a^r^k^e^{d a}^g^aⁱ^ns^{t or}^be^nc^hm^a^r^k^e^quiv^a^le^{nt to the}^s^t^a^t^e^’^s^la^r^g^e^s^{t H}^M^O^.
^{s CMS a}^pprov^a^l^{to use}^pre^s^um^ptiv^e^e^lig^ibility^{but ha}^{s c}^hos^eⁿ^{not to im}^ple^m^eⁿ^{t it. MS a}^l^{so ha}^{s CMS a}^pprov^a^l^{to subsid}^iz^e^ESI^,^{but the}^pr^og^r^a^m^ha^s^{not be}^eⁿ^im^ple^m^eⁿ^te^{d a}^{nd is}^{on hold inde}^fⁱ^nite^ly^.
^Y^o^r^k^C^ity^ha^{d a}^Me^dic^aⁱ^{d a}^{nd SC}^H^I^P^Dⁱ^s^a^s^t^e^r^R^e^lie^f^w^a^iv^e^r^{to a}^ddr^e^s^s^the^e^f^f^e^c^t^s^of^Se^{pt. 11, 2001. T}^h^e^w^a^iv^e^r^w^a^s^e^f^f^e^c^tiv^e^A^u^g^.^{1, 2001 thr}^oug^{h J}^a^{n. 31, 2003.}
^a^{s recei}^ved^ap^p^r^o^v^al^f^o^{r a S}^ectⁱ^oⁿ^{1115 w}^a^iv^e^r^a^llowⁱ^ng^aⁿ^a^nnua^{l e}ⁿ^r^o^llm^eⁿ^{t f}^e^e^a^{nd 12 m}^onths^c^ontinuous^c^o^v^e^r^a^g^e^f^o^r^be^ne^fⁱ^cⁱ^a^r^ie^s^w^ith^inc^o^m^e^be^tw^e^eⁿ^151-^200%^F^P^L^;^h^o^w^ever,^t^h^{e st}^at^{e h}^a^{s ch}^o^s^en
^ple^m^eⁿ^{t the}^w^a^iv^e^r^.
^sta^r^{t of}^SCHIP^,^se^v^e^ra^{l sta}^t^e^s^{, inc}^l^uding^T^N^{, c}^r^e^a^t^e^d^MX^P^s^{to c}^o^v^e^{r olde}^{r c}^h^ildre^{n in f}^a^m^ilie^{s w}^ith^inc^o^m^e^up^to¹⁰⁰^%^FP^L^s^oone^r^thaⁿ^r^e^quir^e^{d by}^Me^dic^aⁱ^{d la}^w^.^A^s^of^O^c^{t. 1, 2002,}^s^u^c^h^c^h^ildr^eⁿ
^e^r^e^c^o^v^e^r^e^{d a}^s^a^m^a^nda^tor^y^g^r^oup^unde^r^Me^dic^aⁱ^d,^a^{nd thus}^{, pr}^e^v^ious^ly^e^s^ta^blis^he^{d MXP}^s^f^o^r^the^s^e^c^h^ildr^eⁿ^ceased^t^o^exi^s^t^.^T^h^u^s^,^T^N^h^a^{s n}^o^S^C^HIP^en^ro^l^l^m^en^t^.^T^eⁿⁿ^e^{ssee’s S}^ectⁱ^oⁿ^{1115 w}^a^iv^e^r^a^llow^s
^en^ro^l^l^m^en^t^cap^,^b^u^t^su^ch^{a cap}^h^a^{s n}^o^t^b^eenⁱ^m^p^l^em^en^t^e^d^.

Appendix 3. SCHIP Premiums/Enrollment Fees and Selected Co-Payment Amounts by State, as of July 31, 2003
^Slidⁱⁿ^g
^{scale for}
^cost^Co^-p^a^y^{s fo}^r^Co^-p^a^y^{s fo}^r
^Cost^sh^arin^g^Co-p^ay^s^Co-p^ay^s^em^erg^en^cyⁿ^oⁿ^-^em^er-
^sh^arin^g⁽^b^{ased on}^P^remⁱ^u^m^or^fo^{r b}^r^aⁿ^d^{for g}^eⁿ^eri^c^Co-p^ay^s^Co^-p^a^y^{s fo}^r^u^s^{e of em}^er-^geⁿ^c^{y u}^s^e^o^f
^MX^P^SSP^Com^b^i-^req^uⁱ^redⁱⁿ^c^o^m^e^o^r^en^rol^l^m^en^t^P^remⁱ^u^m^{or fee}^Fa^m^{ily c}^a^p^nam^e^R^x^R^x^dr^ug^s^fo^{r o}^fficeⁱ^npatⁱ^eⁿ^t^geⁿ^c^{y r}^o^o^m^em^erg^en^cy
^onl^y^onl^y^natⁱ^on^(y^es/n^o⁾^ag^e)^{fee req}^uⁱ^red^p^{er ch}ⁱ^l^d^($⁾^($⁾^dr^ug^s⁽^$⁾^($⁾^vⁱ^{sits ($}⁾^servi^{ces ($}⁾^($⁾^room⁽^$⁾
^X^y^e^s^inc^o^m^e^a^nnua^lly^0-⁵⁰^0-¹⁵⁰^0-³⁰^-¹^0-⁵⁰^-⁵^0-⁵⁰^-⁵
^X^y^e^s^a^a^g^eⁿ^o^—^—^0-²⁰^-²^0-³⁰^-⁵⁰^—^0-^5%^of^c^h^a^r^g^e
^X^y^esⁱⁿ^co^m^e^m^oⁿ^t^h^l^y⁰^-1⁵⁰^-2⁰^—^—^—^—^—⁵
^X^y^e^s^no^no^—^—⁵⁵¹⁰^20%^of^fⁱ^r^s^t^hos^pita^{l da}^y¹⁰¹⁰
^X^y^esⁱⁿ^co^m^e^d^4-⁹⁸^-²⁷⁵⁵⁵^—⁵⁵
ⁱ^{ki/CRS-RL32389}^X^y^e^s^inc^o^m^e^a^nnua^lly^0-²⁵^0-³⁵^1-⁵¹^-³^2-⁵^—^3-¹⁵^3-¹⁵
^g/w^X^y^e^s^inc^o^m^e^m^onthly⁰^-³⁰⁰^-⁵⁰⁶³⁵^—^—²⁵
^s^.or
^le^ak^X^y^e^s^inc^o^m^e^m^onthly^10-²⁵^10-²⁵^—^—^—^—^—¹⁰
^://wiki^X^{^}^{^}^{^}^{^}^{^}^{^^}^{^^}^{^}^{^}
^h^ttp^X^y^e^s^no^m^onthly¹⁵¹⁵⁰^-³^0-³⁰^-³^—^—^0-¹⁰
^X^y^es^ag^e^m^oⁿ^t^h^l^y⁰^-7^.5⁰⁰^-1⁵^—^—^—^—^—^—
^X^{^}^{^}^{^}^{^}^{^}^{^^}^{^^}^{^}^{^}
^X^{^}^{^}^{^}^{^}^{^}^{^^}^{^^}^{^}^{^}
^X^y^e^s^no^m^onthly⁰^-¹⁵⁰^-³⁰²^-⁵^2-³²^-⁵^—^2-^{no inf}^o^2-²⁵
^X^y^e^s^inc^o^m^e^m^onthly^11-^16.50^16.50-^24.75¹⁰³^—^—^—^—
^X^y^esⁱⁿ^co^m^e^m^oⁿ^t^h^l^y⁰^-1⁰⁰^-2⁰^—^—^—^—^—⁰^-²⁵
^X^y^e^s^inc^o^m^e^m^onthly^10-¹⁵^10-¹⁵^—^—^—^—^—^—
^X^y^es^a^ag^eⁿ^o^—^—⁰^-¹⁰^-1^—^—^—^—
^X^{^}^{^}^{^}^{^}^{^}^{^^}^{^^}^{^}^{^}
^X^y^esⁱⁿ^co^m^e^m^oⁿ^t^h^l^y⁵^-2⁰¹⁰^-⁴⁰^—^—^—^—^—^—

^Slidⁱⁿ^g
^{scale for}
^cost^Co^-p^a^y^{s fo}^r^Co^-p^a^y^{s fo}^r
^Cost^sh^arin^g^Co-p^ay^s^Co-p^ay^s^em^erg^en^cyⁿ^oⁿ^-^em^er-
^sh^arin^g⁽^b^{ased on}^P^remⁱ^u^m^or^fo^{r b}^r^aⁿ^d^{for g}^eⁿ^eri^c^Co-p^ay^s^Co^-p^a^y^{s fo}^r^u^s^{e of em}^er-^geⁿ^c^{y u}^s^e^o^f
^MX^P^SSP^Com^b^i-^req^uⁱ^redⁱⁿ^c^o^m^e^o^r^en^rol^l^m^en^t^P^remⁱ^u^m^{or fee}^Fa^m^{ily c}^a^p^nam^e^R^x^R^x^dr^ug^s^fo^{r o}^fficeⁱ^npatⁱ^eⁿ^t^geⁿ^c^{y r}^o^o^m^em^erg^en^cy
^onl^y^onl^y^natⁱ^on^(y^es/n^o⁾^ag^e)^{fee req}^uⁱ^red^p^{er ch}ⁱ^l^d^($⁾^($⁾^dr^ug^s⁽^$⁾^($⁾^vⁱ^{sits ($}⁾^servi^{ces ($}⁾^($⁾^room⁽^$⁾
^X^{^}^{^}^{^}^{^}^{^}^{^^}^{^^}^{^}^{^}
^X^y^e^s^inc^o^m^e^m^onthly^f^15-¹⁸^15-¹⁸^5-²⁰^0-⁵²^-¹⁰^25-¹⁰⁰^5-⁵⁰^5-⁵⁰
^X^y^e^s^inc^o^m^e^qua^r^t^e^r^ly^13-²⁵^13-²⁵^2-⁵²^-⁵^5-¹⁵^{5 or}^10%^of^a^llow^e^{d a}^m^t^5-³⁵^10-³⁵
^X^y^esⁿ^o^m^oⁿ^t^h^l^y⁵⁰⁵⁰^—^—^—^—^—^—
^X^y^e^s^inc^o^m^e^no^—^—^2-⁵²^-⁵^2-⁵^15-²⁵^—^10-²⁵
^X^y^esⁿ^o^m^oⁿ^t^h^l^y¹⁰³⁰^—^—^—^—^—^—
^X^y^e^s^inc^o^m^e^no^—^—^5-¹⁵^—^0-¹⁵^0-²⁵^0-³⁵^0-³⁵
ⁱ^{ki/CRS-RL32389}
^g/w^X^y^e^s^inc^o^m^e^m^onthly^{0 or}^3%^of^{0 or}^3%^of^—^—^—^—^—^—
^s^.or^inc^o^m^e^inc^o^m^e
^le^ak^X^y^esⁿ^oⁿ^o^—^—⁵³⁵^—⁵⁵
^://wiki²²^m^o^nt^hl^y
^h^ttp¹⁵¹⁸¹⁸³⁸^{25 in}^c^o^m^e^{3 a}^g^e²^q^u^a^rterl^y³^annual^l^y²⁸²⁸²²²¹²⁰⁹¹⁵²³
^{2 m}ⁱ^x^e^d
^t^-s^ha^ring^f^o^{r c}^h^ildre^{n is}^{not pe}^rm^itte^{d unde}^{r Me}^dic^aⁱ^{d unle}^s^s^the^s^t^a^t^e^ha^s^a^Se^c^tion¹¹¹⁵^w^a^iv^e^r^a^llowⁱ^ng^the^s^t^a^t^e^to^im^p^os^e^c^o^s^t^s^h^a^r^ing^.^T^h^is^a^l^s^o^a^pplie^s^{to SC}^H^I^P^Me^dic^aⁱ^{d e}^x^pa^ns^{ion pr}^og^r^a^m^s^.
^{d e}^x^pa^ns^{ion only}^s^t^a^t^e^s^w^{ithout a}ⁿ^{1115 w}^a^iv^e^r^ha^v^e^a^‘^{^}^’^{in the}^c^o^s^t^-^s^ha^rⁱ^ng^c^o^lumⁿ^s^.^For^the^c^o^m^b^ina^tion^s^t^a^t^e^s^,^the^v^a^lue^s^s^how^{n r}^e^f^l^e^c^t^c^o^s^t^-^s^ha^rⁱ^ng^{in the}^s^e^pa^r^a^te^s^t^a^t^e^pr^og^r^a^m⁽^s⁾^only^.^Som^e^s^t^a^t^e^s
^ploy^e^r^-^s^pons^or^e^d^ins^u^r^a^nc^e⁽^E^SI⁾^pr^og^r^a^m^s^a^s^a^c^o^m^pone^{nt of}^theⁱ^r^Me^dic^aⁱ^{d e}^x^pa^ns^{ion or}^s^e^pa^r^a^te^s^t^a^t^e^pr^og^r^a^m^s^{. I}ⁿ^f^o^r^m^a^{tion on c}^o^s^t^-^s^ha^rⁱ^ng^{in ESI}^pr^og^r^a^m^s^v^a^rⁱ^e^s^by^pa^r^tic^ipa^ting^e^m^ploy^e^r^aⁿ^d
^lly^{not a}^v^a^ila^ble^{in s}^t^a^t^e^SC^H^I^P^doc^um^eⁿ^ts^a^{nd othe}^r^s^our^c^e^s^us^e^d^f^o^r^this^aⁿ^a^l^y^s^is^{. T}^hus^{, s}^u^c^h^da^ta^a^r^e^{not r}^e^pr^e^s^eⁿ^te^{d in this ta}^ble^.
^,¹⁸^-^y^ear-o^l^d^{s are su}^b^j^ect^t^o^t^h^{e M}^e^dⁱ^cai^d^co^-p^ay^m^eⁿ^t^req^uⁱ^rem^eⁿ^t^{s f}^o^{r ad}^u^l^t^s^.^Lⁱ^kewⁱ^se,^{KY ch}^{arges 1}⁸^-^y^ear-o^l^d^{s co}^p^a^y^m^e^nts^{on pr}^e^s^c^r^{iption dr}^ug^s^.
^s^a^Se^c^{tion 1115 w}^a^iv^e^r^a^llowⁱ^ng^c^o^s^t^-^s^ha^rⁱ^ng^{in a}^Me^dic^aⁱ^{d e}^x^pa^ns^{ion pr}^og^r^a^m^.
^s^t^a^t^e^s^ha^v^e^m^u^ltiple^s^e^pa^ra^te^s^t^a^t^e^prog^ra^m^s^{. T}^h^e^a^m^ounts^s^how^{n in the}^s^e^c^e^lls^re^pre^s^eⁿ^{t c}^o^s^t^-s^ha^ring^ra^ng^e^s^a^c^r^os^s^a^{ll SSP}^{s w}^{ithin the}^sta^t^e^.
^of^C^a^lif^or^nia^’^s^SSP^s^,^the^A^c^c^e^s^s^f^o^r^Iⁿ^f^a^nts^a^{nd Mothe}^r^s^P^r^og^r^a^m^,^aⁿ^eⁿ^r^o^llm^eⁿ^t^f^e^e^of^2%^of^f^a^m^ily^inc^o^m^e^is^r^e^quir^e^d^f^o^r^inf^a^nts⁽^p^aⁱ^{d on a}^m^onthly^or^a^nnua^{l ba}^sⁱ^s⁾^{. N}^o^c^o^-^p^a^y^m^e^nts^a^pply^{to this}
^r^{oup. T}^h^e^m^onthly^pre^m^ium^s^a^{nd c}^o^-pa^y^m^e^nts^s^how^{n f}^o^{r CA}^a^r^e^f^o^{r the}^s^t^a^t^e^’^s^othe^{r SSP}^c^a^lle^{d H}^e^a^lthy^Fa^m^ilie^s^.
^a^{s recei}^ved^ap^p^r^o^v^a^l^f^o^{r a S}^ectⁱ^oⁿ^{1115 w}^a^iv^e^r^a^llowⁱ^ng^aⁿ^a^nnua^{l e}ⁿ^rollm^eⁿ^{t f}^e^e^a^{nd 12 m}^onths^c^ontinuous^c^o^v^e^ra^g^e^f^o^{r c}^h^ildre^{n in f}^a^m^ilie^s^w^{ith inc}^o^m^e^be^tw^e^eⁿ¹⁵^1-^200%^FP^L^;^how^e^v^e^r^{, the}^s^t^a^t^e
^a^{s ch}^o^s^enⁿ^o^t^t^oⁱ^m^p^l^em^en^t^t^h^{e w}^aⁱ^v^er.
^{, c}^h^ildre^{n in f}^a^m^ilie^s^w^{ith inc}^o^m^e^be^tw^e^eⁿ^100-150%^FP^L^pa^y^a^{$15 a}^nnua^{l e}ⁿ^rollm^eⁿ^{t f}^e^e^only^.^Monthly^pre^m^ium^s^a^pply^t^{o othe}^r^c^h^ildr^e^n.

Appendix 4. SCHIP State Tables, Status
as of December 31, 2002 through July 31, 2003
^Pr^o^g^r^a^m^In^fo
^Sta^t^e^A^l^abama.^Se^pa^ra^te^Sta^t^e^P^r^og^ra^m^Oⁿ^ly
^P^r^o^g^ram^Nam^e^CHIP^P^h^{ase II- A}^L^L^Kid^s
^T^y^p^e^Of^P^r^o^g^ram^S^ep^arat^{e S}^t^at^{e P}^r^o^g^ram
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^is^e^A^f^f^e^c^ting^{this P}^r^og^ra^mⁿ^o
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r^G^r^oups^N^o^t
^Elig^ible^f^o^{r this P}^r^og^ra^mⁿ^o
^Eligib^ility
^A^g^e^I^nc^om^e⁽^%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t⁰⁵¹³³²⁰⁰
^N^e^x^t^Y^oung^e^s^t⁶¹⁸¹⁰⁰²⁰⁰
^Old^e^r
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregard^y^es
^A^{sset T}^e^stsⁿ^o
^Continuous^Elig^ibility^(m^onths⁾¹²
^P^r^e^s^um^ptiv^e^Elig^ibility^no
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿⁿ^o
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^y^es
^Sliding^Sc^a^l^e^f^o^{r Cost-Sha}^ring^inc^o^m^e
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d^G^r^{oup 1}^G^r^{oup 2}^G^r^{oup 3}^G^r^{oup 4}
^Ran^g^{e (%}^FP^L⁾¹⁰⁰¹⁵⁰¹⁵⁰²⁰⁰
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d^a^nnua^lly
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d^$⁰^$⁵⁰
^Fa^m^ily^Ca^p^$⁰^$¹⁵⁰
^Co^-Pa^y^m^e^nts
^C^o^-^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s^$⁰^$³
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s^$⁰^$¹
^Co^-P^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s^$⁰^$⁵
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s^$⁰^$⁵
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}^E^m^erg-Ro^o^m^$⁰^$⁵
^Co^-P^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}^E^m^erg-Ro^o^m^$⁰^$⁵
^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^T^y^pe^B^e^nc^hm^a^r^k
^Op^tioⁿ^L^{argest HM}^O
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^{d-Out (m}^onths)³
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r^Subs^idy^N^A

^Pr^o^g^r^a^m^In^fo
^Sta^t^e^A^l^aska.^Me^dic^aⁱ^{d Ex}^pa^ns^{ion O}ⁿ^ly
^P^r^o^g^ram^Nam^e^Den^a^{li Kid}^C^are
^T^y^pe^O^f^P^r^og^r^a^m^M^e^d^ic^aⁱ^{d Ex}^pa^ns^ion
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^is^e^A^f^f^e^c^ting^{this P}^r^og^ra^mⁿ^o
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r^G^r^oups^N^o^t
^Elig^ible^f^o^{r this P}^r^og^ra^mⁿ^o
^Eligib^ility
^A^g^e^I^nc^om^e⁽^%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t⁰⁵¹³³²⁰⁰
^N^e^x^t^Y^oung^e^s^t⁶¹⁸¹⁰⁰²⁰⁰
^Old^e^r
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregard^y^es
^A^{sset T}^e^stsⁿ^o
^Continuous^Elig^ibility^(m^onths⁾⁶
^P^r^e^s^um^ptiv^e^Elig^ibility^no
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿ^N^A
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^y^es^a
^S^lⁱ^dⁱⁿ^{g S}^cal^{e f}^o^{r Co}^st^-S^h^a^riⁿ^g^age^a
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d^G^r^{oup 1}^G^r^{oup 2}^G^r^{oup 3}^G^r^{oup 4}
^Ran^g^{e (%}^FP^L⁾⁰¹⁸¹⁷¹⁸
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d^no
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d
^Fa^m^ily^Ca^p
^Co^-Pa^y^m^e^nts
^C^o^-^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s^$⁰^$²
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s^$⁰^$²
^Co^-P^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s^$⁰^$³
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s^$⁰^$50^b
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}^E^m^erg-Ro^o^m^$⁰^$⁰
^5%^of
^Co^-P^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}^E^m^erg-Ro^o^m^$⁰^ch^arge
^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^Ty^p^e^N^A
^Option^N^A
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^{d-Out (m}^onths)^c
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r^Subs^idy^N^A
^a^.^Iⁿ^A^K^{, 18 y}^e^a^r^olds^a^r^e^s^ubje^c^t^{to the}^Me^dic^aⁱ^{d c}^o^-^p^a^y^m^e^{nt r}^e^quir^e^m^e^nts^f^o^r^a^dults^.
^{b. U}^p^{to a}^m^a^xⁱ^m^u^m^of^{$200 f}^o^r^inpa^tie^{nt hos}^pita^{l s}^e^r^v^ic^e^s^{, not}^to^e^x^ceed⁵⁰^%^o^f^t^h^{e p}^a^y^m^en^t^m^a^d^e^f^o^{r t}^h^{e f}ⁱ^rst
^da^y^of^hos^pita^{l c}^a^r^e^.
^c^.^A^K^ha^s^a^Se^c^{tion 1115 w}^a^iv^e^r^pe^nding^tha^t^w^{ould a}^llow^{it t}^o^r^e^q^uⁱ^r^e^a¹²^-^m^o^{nth w}^a^iting^pe^{riod prior to}
^eⁿ^rollm^eⁿ^{t f}^o^{r c}^h^ildre^{n in f}^a^m^ilie^s^w^{ith inc}^o^m^e^ov^e^r^150%^.

^Pr^o^g^r^a^m^In^fo
^Sta^t^e^A^r^izona.^Se^pa^ra^te^Sta^t^e^P^r^og^ra^m^Oⁿ^ly
^P^r^o^g^r^a^{m N}^a^me^Kⁱ^d^s^C^a^r^e
^T^y^p^e^Of^P^r^o^g^ram^S^ep^arat^{e S}^t^at^{e P}^r^o^g^ram
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^is^e^A^f^f^e^c^ting^{this P}^r^og^ra^mⁿ^o
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r^G^r^oups^N^o^t^a
^Elig^ible^f^o^{r this P}^r^og^ra^m^y^e^s
^Eligib^ility
^A^g^e^I^nc^om^e⁽^%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t⁰¹¹⁴⁰²⁰⁰
^N^e^x^t^Y^oung^e^s^t¹⁵¹³³²⁰⁰
^O^l^de^r⁶¹⁸¹⁰⁰²⁰⁰
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregardⁿ^o
^A^{sset T}^e^stsⁿ^o
^Continuous^Elig^ibility^(m^onths⁾¹²
^P^r^e^s^um^ptiv^e^Elig^ibility^no
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿⁿ^o
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^y^es
^Sliding^Sc^a^l^e^f^o^{r Cost-Sha}^ring^inc^o^m^e
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d^G^r^{oup 1}^G^r^{oup 2}^G^r^{oup 3}^G^r^{oup 4}
^Ran^g^{e (%}^FP^L⁾¹⁰⁰¹⁵⁰¹⁷⁵¹⁵⁰¹⁷⁵²⁰⁰
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d^m^onthly
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d^$⁰^$¹⁰^$¹⁵
^Fa^m^ily^Ca^p^$⁰^$¹⁵^$²⁰
^Co^-Pa^y^m^e^nts
^C^o^-^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s^$⁰^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s^$⁰^$⁰^$⁰
^C^o^-^P^a^y^m^eⁿ^t^F^o^r^O^fⁱ^c^e^Vⁱ^s^t^$0^$0^$0
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s^$⁰^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}^E^m^erg-Ro^o^m^$⁰^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}^E^m^erg-Ro^o^m^$⁵^$⁵^$⁵
^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^T^y^p^e^S^ecret^ary^A^p^p^r^o^v^ed
^Op^tⁱ^oⁿ^S^am^{e as M}^e^dⁱ^cai^d
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^{d-Out (m}^onths)³
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r^Subs^idy^N^A
^a^.^A^r^iz^ona^’^s^H^I^FA^w^a^iv^e^r^a^llow^s^the^s^t^a^t^e^{to us}^e^SC^H^I^P^f^unds^to^c^o^v^e^r^pa^r^e^nts^of^SC^H^I^P^a^nd^Me^dic^aⁱ^{d c}^h^ildr^eⁿ
^{in f}^a^m^ilie^s^w^{ith inc}^o^m^e^be^tw^e^eⁿ^100%^-200%^FP^L^a^{nd a}^dults^w^{ithout de}^pe^ndeⁿ^t^childre^{n w}^{ith inc}^o^m^e
^be^low^100%^FP^L^.

^Pr^o^g^r^a^m^In^fo
^Sta^t^e^A^r^kansas.^Me^dic^aⁱ^{d Ex}^pa^ns^{ion O}ⁿ^ly
^P^r^o^g^r^a^{m N}^a^me^AR^Kⁱ^d^s^B
^T^y^pe^O^f^P^r^og^r^a^m^M^e^d^ic^aⁱ^{d Ex}^pa^ns^ion
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^is^e^A^f^f^e^c^ting^{this P}^r^og^ra^m^y^e^s^a
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r^G^r^oups^N^o^t
^Elig^ible^f^o^{r this P}^r^og^ra^mⁿ^o
^Eligib^ility
^A^g^e^I^nc^om^e⁽^%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t⁰¹⁸¹⁵⁰²⁰⁰
^N^e^x^t^Y^oung^e^s^t
^Old^e^r
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregard^y^es
^A^{sset T}^e^stsⁿ^o
^Continuous^Elig^ibility^(m^onths⁾¹²
^P^r^e^s^um^ptiv^e^Elig^ibility^no
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿ^N^A
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^y^es
^Slidⁱⁿ^g^{Scale f}^o^{r Co}^st-Sh^a^rin^gⁿ^o
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d^G^r^{oup 1}^G^r^{oup 2}^G^r^{oup 3}^G^r^{oup 4}
^Ran^g^{e (%}^FP^L⁾
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d^no
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d
^Fa^m^ily^Ca^p
^Co^-Pa^y^m^e^nts
^C^o^-^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s^$⁵
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s^$⁵
^Co^-P^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s^$¹⁰
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s^20%^of¹^st^hos^pita^{l da}^y
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}^E^m^erg-Ro^o^m^$¹⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}^E^m^erg-Ro^o^m^$¹⁰
^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^T^y^pe^C^o^m^p^r^e^he^ns^iv^e^Me^dic^aⁱ^{d Se}^c^{tion 1115 w}^a^iv^e^r
^Option^N^A
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^{d-Out (m}^onths)⁶
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r^Subs^idy^N^A
^a^.^A^R^us^e^s^SC^H^I^P^f^unds^{to pr}^ov^ide^c^o^v^e^r^a^g^e^unde^r^its^c^o^m^p^r^e^he^ns^iv^e^Me^dic^aⁱ^d^Se^c^tion¹¹¹⁵^w^a^iv^e^r^,^w^h^ic^h,
^am^oⁿ^g^o^t^h^e^r^thⁱⁿ^g^s^,^allo^w^s^a^six^-^m^oⁿ^t^h^w^a^itin^g^p^e^rio^d^an^d^co^{st sh}^arin^g^th^{at ex}^ceed^{s M}^e^dⁱ^caid^allo^w^a^b^l^e
^a^m^ounts^.

^Pr^o^g^r^a^m^In^fo
^Sta^t^e^California.^Com^b^ina^tion
^P^r^og^r^a^m^N^a^m^e^Me^diC^a^l^A^c^c^e^s^s^f^o^r^Iⁿ^f^a^nts^a^{nd Mothe}^r^s^b^He^a^lthy^Fa^m^ilie^{s P}^r^og^ra^m
^T^y^p^e^Of^P^r^o^g^ram^M^edⁱ^cai^d^E^x^p^aⁿ^sⁱ^oⁿ^S^ep^arat^{e S}^t^at^{e P}^r^o^g^ram^S^ep^arat^{e S}^t^at^{e P}^r^o^g^ram
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^ise^A^f^f^e^c^ting^this
^Pr^o^g^r^a^mⁿ^oⁿ^oⁿ^o
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r^G^r^oups^c^c^c
^{Not Elig}^ible^f^o^{r this P}^r^og^ra^m^y^e^s^ye^s^ye^s
^Eligib^ility
^A^g^e^I^nc^om^e⁽^%^FP^L⁾^A^g^e^I^nc^om^e⁽^%^FP^L⁾^A^g^e^I^nc^om^e⁽^%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t¹⁵¹^a¹³³^a⁰¹²⁰⁰²⁵⁰⁰¹²⁰⁰²⁵⁰
^N^e^x^t^Y^oung^e^s^t⁶¹⁸¹^a¹⁰⁰^a¹⁵¹³³²⁵⁰
^Old^e^r⁶¹⁸¹⁰⁰²⁵⁰
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregard^y^es^y^e^s^y^es
ⁱ^{ki/CRS-RL32389}^A^{sset T}^e^stsⁿ^oⁿ^oⁿ^o
^g/w^Continuous^Elig^ibility^(m^onths⁾¹²¹²¹²
^s^.or^P^r^e^s^um^ptiv^e^Elig^ibility^y^e^sⁿ^oⁿ^o
^le^ak^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿ^N^Aⁿ^oⁿ^o
^://wiki^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no^no^no
^h^ttp^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^N^A^y^es^y^e^s
^Sliding^Sc^a^l^e^f^o^r^C^o^s^t^-^S^ha^rⁱ^ng^N^A^y^e^sⁱ^nc^om^e^e
^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d¹²³⁴¹²³⁴¹²³⁴
^Ran^g^{e (%}^FP^L⁾¹⁰⁰¹⁵⁰¹⁰⁰¹⁵⁰¹⁵⁰²⁰⁰¹⁵⁰²⁰⁰
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d^m^onthly^or^a^nnua^lly^d^m^onthly^e
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d^2%^of^f^a^m^ily^inc^o^m^e^$4^$⁶^$7^$⁹
^Fa^m^ily^Ca^p^$8^$¹⁸^$¹⁴^$²⁷
^Co^-Pa^y^m^e^nts
^C^o^-^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s^$5^$⁵^$5^$⁵
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s^$5^$⁵^$5^$⁵
^Co^-P^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s^$5^$⁵^$5^$⁵
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s^$0^$⁰^$0^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}^E^m^erg-Ro^o^m^$⁵^$⁵^$⁵^$⁵
^Co^-P^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}^E^m^erg-Ro^o^m^$⁵^$⁵^$⁵^$⁵

^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^T^y^pe^N^A^B^e^nc^hm^a^r^k^B^eⁿ^c^h^m^a^r^k
^O^p^tion^N^A^S^ta^te^Em^ploy^e^e^Sta^t^e^Em^ploy^e^e
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^{d-Out (m}^onths)⁰⁰³
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no^no^no
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r
^Subs^idy^N^A^N^A^N^A
^a^.^T^h^e^inc^o^m^e^thr^e^s^holds^s^how^{n a}^r^e^us^e^d^f^o^r^{both Me}^dic^aⁱ^d^an^d^S^C^HI^P^pur^pos^e^s^{. C}^A^e^lim^ina^t^e^d^a^s^s^e^{t te}^s^t^s^f^r^om^its^Me^dic^aⁱ^{d pr}^og^ra^m^{in 1998. T}^itle^X^I^X
^fⁱ^na^nc^ing^{is use}^d^f^o^{r c}^h^ildre^{n w}^{ho m}^e^e^t^the^inc^o^m^e^thre^{sholds s}^howⁿ^a^nd^w^{ho ha}^v^e^a^sse^{ts be}^low^the^T^itle^X^I^X^a^sse^{t te}^{st thre}^shol^d^sⁱⁿ^p^l^{ace i}ⁿ^{1997 (}^t^he
^m^a^inte^na^nc^e^of^e^f^f^o^{rt point f}^o^{r SCHIP}⁾^{. T}^itle^X^X^I^fⁱ^na^nc^ing^is^use^d^f^o^{r c}^h^ildre^{n w}^{ho m}^e^e^t^theⁱⁿ^c^o^m^e^thre^sholds^show^{n a}^nd^w^ho^h^a^{ve assets}^ex^ceedⁱⁿ^g
^th^{e T}^{itle X}^I^X^{asset test}^th^resh^o^l^d^sⁱⁿ^p^l^{ace in}^1997.
^b.^Oⁿ^ly^inf^a^nts^borⁿ^to^w^o^m^e^{n a}^l^r^e^a^d^y^eⁿ^r^o^lle^{d in C}^a^lif^or^nia^’^s^non-^SC^H^I^P^A^I^{M pr}^og^r^a^m^a^r^e^eⁿ^r^o^lle^{d in A}^I^{M. O}^t^he^r^inf^a^nts^200-²⁵^0%^FP^L^a^r^e^eⁿ^rolle^{d in}^the
^He^a^lthy^Fa^m^ilie^{s prog}^ra^m^.
^c^.^C^a^lif^or^nia^’^s^H^I^FA^w^a^iv^e^r^a^llow^s^the^s^t^a^t^e^{to us}^e^SC^H^I^P^f^unds^{to c}^o^v^e^r^pa^r^e^nts^,^r^e^la^tiv^e^c^a^r^e^t^a^k^e^r^s^,^a^{nd le}^g^a^{l g}^u^a^r^diaⁿ^s^of^e^lig^ible^c^h^ildre^{n in f}^a^m^ilie^{s w}^{ho a}^r^e
^not^e^lig^ible^f^o^r^Me^dic^aⁱ^d^w^ith^f^a^m^ily^inc^o^m^e^{up to 200%}^FP^L⁽^T^he^w^a^iv^e^r^w^a^s^a^ppr^ov^e^d^J^a^{n. 2002 but ha}^{d not}^y^e^t^be^eⁿ^im^ple^m^eⁿ^te^{d a}^s^of^J^une^{12, 2003)}^.
ⁱ^{ki/CRS-RL32389}
^g/w^d^.^T^h^{e A}^I^M^f^a^m^ily^coⁿ^t^rib^u^tioⁿ^can^b^e^eith^{er (1}^{) p}^a^id^at^th^e^tim^e^o^f^th^e^ap^p^licatioⁿ^an^d^th^{e ap}^p^lican^{t w}^{ill receiv}^e^a^$50^dis^c^{ount, or}⁽²⁾^s^p^r^e^a^d^ov^e^r^a^{12 m}^onth^pe^{riod. If}^the^a^pplic^aⁿ^{t c}^hoos^e^s^m^onthly^pa^y^m^eⁿ^ts^{, s}^h^e^m^u^s^t^s^e^{nd $50 w}^{ith the}^a^pplic^a^{tion a}^{nd the}^prog^ra^m^w^{ill s}^e^{nd he}^{r a}^pa^y^m^eⁿ^{t book}^le^t.
^s^.or
^le^ak^e^.^Enr^o^lle^e^s^m^a^y^c^hoos^e^f^r^om^tw^{o pr}^ov^ide^r^plaⁿ^s^.^P^r^e^m^ium^s^f^o^r^the^“^C^om^m^unity^P^r^ov^ide^r^P^l^aⁿ^”^a^r^e^pr^e^s^eⁿ^te^{d in}^the^fⁱ^r^s^t^tw^o^c^o^l^um^{ns; pre}^m^ium^s^f^o^{r the}^“^F^a^m^ily
^V^a^lue^P^a^c^k^a^g^e^”^a^r^e^pre^s^eⁿ^te^{d in the}^s^e^c^{ond tw}^{o c}^o^lumⁿ^s^.^Fa^m^ilie^s^w^{ho pre}^-^pa^y^thre^e^m^onths^{do not}^ha^v^e^{to pa}^y^the^f^{ourth m}^onth^.

^://wiki
^h^ttp

^Pr^o^g^r^a^m^In^fo
^Sta^t^e^Colorado.^Se^pa^ra^te^Sta^t^e^P^r^og^ra^m^Oⁿ^ly
^P^r^og^ra^m^Na^m^e^{Child He}^a^{lth P}^l^aⁿ^P^l^us
^T^y^p^e^Of^P^r^o^g^ram^S^ep^arat^{e S}^t^at^{e P}^r^o^g^ram
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^is^e^A^f^f^e^c^ting^{this P}^r^og^ra^mⁿ^o
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r^G^r^oups^N^o^t^a
^Elig^ible^f^o^{r this P}^r^og^ra^m^y^e^s
^Eligib^ility
^A^g^e^I^nc^om^e⁽^%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t⁰⁵¹³³¹⁸⁵
^N^e^x^t^Y^oung^e^s^t⁶¹⁸¹⁰⁰¹⁸⁵
^Old^e^r
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregard^y^es
^A^{sset T}^e^stsⁿ^o
^Continuous^Elig^ibility^(m^onths⁾¹²
^P^r^e^s^um^ptiv^e^Elig^ibility^no
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿⁿ^o
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^y^es
^Sliding^Sc^a^l^e^f^o^{r Cost-Sha}^ring^inc^o^m^e
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d^G^r^{oup 1}^G^r^{oup 2}^G^r^{oup 3}^G^r^{oup 4}
^Ran^g^{e (%}^FP^L⁾¹⁰⁰¹⁵⁰¹⁵⁰¹⁸⁵
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d^a^nnua^lly
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d^$⁰^$²⁵
^Fa^m^ily^Ca^p^$⁰^$³⁵
^Co^-Pa^y^m^e^nts
^C^o^-^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s^$¹^$⁵
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s^$¹^$³
^Co^-P^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s^$²^$⁵
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}^E^m^erg-Ro^o^m^$³^$¹⁵
^Co^-P^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}^E^m^erg-Ro^o^m^$³^$¹⁵
^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^T^y^pe^B^e^nc^hm^a^r^k^Equiv^a^le^nt
^Op^tⁱ^oⁿ^F^E^H^BP^,^S^t^at^{e E}^m^p^l^o^y^ee,^an^d^L^a^rgest^HM^O
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^{d-Out (m}^onths)³
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r^Subs^idy^N^A
^a^.^C^o^lor^a^do’^s^H^I^FA^w^a^iv^e^r^a^llow^s^the^s^t^a^t^e^{to us}^e^SC^H^I^P^f^unds^t^o^exp^aⁿ^d^co^ver^a^g^e^{to pr}^e^g^na^{nt w}^o^m^e^{n w}^ith
^f^a^m^ily^inc^o^m^e^s^be^tw^e^eⁿ^133-^185%^FP^L^.

^Pr^o^g^r^a^m^In^fo
^Sta^t^e^Connecticut.^Se^pa^ra^te^Sta^t^e^P^r^og^ra^m^Oⁿ^ly
^P^r^o^g^ram^Nam^e^HUS^{KY P}^l^an^{s B an}^d^C^a
^T^y^p^e^Of^P^r^o^g^ram^S^ep^arat^{e S}^t^at^{e P}^r^o^g^ram
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^is^e^A^f^f^e^c^ting^{this P}^r^og^ra^mⁿ^o
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r^G^r^oups^N^o^t
^Elig^ible^f^o^{r this P}^r^og^ra^mⁿ^o
^Eligib^ility
^A^g^e^I^nc^om^e⁽^%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t⁰¹⁸¹⁸⁵³⁰⁰
^N^e^x^t^Y^oung^e^s^t
^Old^e^r
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregard^y^es
^A^{sset T}^e^stsⁿ^o
^Continuous^Elig^ibility^(m^onths⁾⁰
^P^r^e^s^um^ptiv^e^Elig^ibility^no
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿⁿ^o
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^y^es
^Sliding^Sc^a^l^e^f^o^{r Cost-Sha}^ring^inc^o^m^e
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d^G^r^{oup 1}^G^r^{oup 2}^G^r^{oup 3}^G^r^{oup 4}
^Ran^g^{e (%}^FP^L⁾¹⁸⁵²³⁵²³⁵³⁰⁰
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d^m^onthly
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d^$⁰^$³⁰
^Fa^m^ily^Ca^p^$⁰^$⁵⁰
^Co^-Pa^y^m^e^nts
^C^o^-^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s^$⁶^$⁶
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s^$³^$³
^Co^-P^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s^$⁵^$⁵
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}^E^m^erg-Ro^o^m^$⁰^$⁰
^C^o^-^P^a^y^m^e^{nt For}^N^on-^Em^e^r^g^U^s^e^O^f^Em^e^r^g^-^R^oom^$²⁵^$²⁵
^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^T^y^pe^B^e^nc^hm^a^r^k
^Option^S^ta^te^Em^ploy^e^e
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^{d-Out (m}^onths)²
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r^Subs^idy^N^A
^a^.^C^h^ildr^e^{n w}^{ho a}^r^e^e^lig^ible^f^o^r^H^U^S^K^Y^P^a^r^t^B^a^nd^w^ho^r^e^quir^e^inte^ns^iv^e^phy^sⁱ^c^a^l^or^be^ha^vⁱ^or^a^l^he^a^{lth s}^e^r^v^ic^e^s
^recei^{ve m}^e^dⁱ^cal^l^yⁿ^ecessary^servi^ces^unde^r^H^U^S^K^Y^P^l^us^P^l^aⁿ^P^a^r^t^C^.

^Pr^o^g^r^a^m^In^fo
^Sta^t^e^Delaw^a^re.^Com^b^ina^tion
^De^la^w^a^re^He^a^lthy^Childreⁿ
^P^r^o^g^r^a^{m N}^a^me^M^e^dⁱ^c^aⁱ^d^Pr^o^g^r^a^m
^T^y^p^e^Of^P^r^o^g^ram^M^edⁱ^cai^d^E^x^p^aⁿ^sⁱ^oⁿ^S^ep^arat^{e S}^t^at^{e P}^r^o^g^ram
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^ise^A^f^f^e^c^ting^this
^Pr^o^g^r^a^mⁿ^oⁿ^o
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r
^G^r^oups^N^o^{t Elig}^ible^f^o^r^this^P^r^og^r^a^mⁿ^oⁿ^o
^Eligib^ility
^In^co^m^e^In^co^m^e
^Ag^e^(%^FP^L⁾^A^g^e^(%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t⁰¹¹⁸⁵²⁰⁰¹⁵¹⁰⁰²⁰⁰
^N^e^x^t^Y^oung^e^s^t⁶¹⁸¹⁰⁰²⁰⁰
^Old^e^r
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregard^y^es^y^e^s
^A^{sset T}^e^stsⁿ^oⁿ^o
^Continuous^Elig^ibility^(m^onths⁾⁰¹²
^P^r^e^s^um^ptiv^e^Elig^ibility^no^no
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿ^N^Aⁿ^o
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no^no
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^N^A^y^es
^Sliding^Sc^a^l^e^f^o^{r Cost-Sha}^ring^NA^inc^o^m^e
^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d¹²³⁴¹²³⁴
^Ran^g^{e (%}^FP^L⁾¹⁰⁰¹³³¹⁶⁶¹³³¹⁶⁶²⁰⁰
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d^m^onthly
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d^$¹⁰^$¹⁵^$²⁵
^Fa^m^ily^C^a^p^$¹⁰^$¹⁵^$²⁵
^Co^-Pa^y^m^e^nts
^C^o^-^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s^$⁰^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s^$⁰^$⁰^$⁰
^C^o^-^P^a^y^m^eⁿ^t^F^o^r^O^fⁱ^c^e^Vⁱ^s^t^s^$0^$0^$0
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s^$⁰^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}
^E^m^e^r^g^-^R^o^m^$0^$0^$0
^Co^-P^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}
^Em^e^r^g^-^R^oom^$¹⁰^$¹⁰^$¹⁰
^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^T^y^pe^N^A^B^e^nc^hm^a^r^k
^Option^N^A^S^ta^te^Em^ploy^e^e
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^d-Out
⁽^m^onths⁾⁰⁶
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no^no
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r
^Subs^idy^N^A^N^A

^Pr^o^g^r^a^m^In^fo
^{District of Columbia.}^Me^dic^aⁱ^{d Ex}^pa^ns^ion
^Sta^t^e^On^ly
^P^r^og^ra^m^Na^m^e^{DC He}^a^lthy^Fa^m^ilie^s
^T^y^pe^O^f^P^r^og^r^a^m^M^e^d^ic^aⁱ^{d Ex}^pa^ns^ion
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^is^e^A^f^f^e^c^ting^{this P}^r^og^ra^mⁿ^o
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r^G^r^oups^N^o^t
^Elig^ible^f^o^{r this P}^r^og^ra^mⁿ^o
^Eligib^ility
^A^g^e^I^nc^om^e⁽^%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t⁰¹¹⁸⁵²⁰⁰
^N^e^x^t^Y^oung^e^s^t¹⁵¹³³²⁰⁰
^O^l^de^r⁶¹⁸¹⁰⁰²⁰⁰
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregard^y^es
^A^{sset T}^e^stsⁿ^o
^Continuous^Elig^ibility^(m^onths⁾⁰
^P^r^e^s^um^ptiv^e^Elig^ibility^no
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿ^N^A
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^N^A
^Slidⁱⁿ^g^{Scale f}^o^{r Co}^st-Sh^a^rin^g^NA
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d^G^r^{oup 1}^G^r^{oup 2}^G^r^{oup 3}^G^r^{oup 4}
^Ran^g^{e (%}^FP^L⁾
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d
^Fa^m^ily^Ca^p
^Co^-Pa^y^m^e^nts
^C^o^-^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s
^Co^-P^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}^E^m^erg-Ro^o^m
^Co^-P^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}^E^m^erg-Ro^o^m
^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^Ty^p^e^N^A
^Option^N^A
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^{d-Out (m}^onths)⁰
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r^Subs^idy^N^A

CRS-34
^g^r^a^m^In^fo
^e^Florida.^Com^b^ina^tion
^ra^m^Na^m^e^Me^dic^aⁱ^d^M^e^d^iKids^F^lorida^{CMS Ne}^tw^ork^a^He^a^lthy^Kids
^e^Of^P^r^o^g^ram^M^edⁱ^cai^d^E^x^p^aⁿ^sⁱ^oⁿ^S^ep^arat^{e S}^t^at^{e P}^r^o^g^ram^S^ep^arat^{e S}^t^at^{e P}^r^o^g^ram^S^ep^arat^{e S}^t^at^{e P}^r^o^g^ram
^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^iv^ing^P^r^ov^{isions Othe}^rw^ise^A^f^f^e^c^ting^this
^m^on^onⁿ
ⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r^G^r^oups^N^o^t
^ible^f^o^{r this P}^r^og^ra^mⁿ^oⁿ^oⁿ^oⁿ^o
^ility
^A^g^e^I^nc^om^e⁽^%^FP^L⁾^A^g^e^I^nc^om^e⁽^%^FP^L⁾^A^g^e^I^nc^om^e⁽^%^FP^L⁾^A^g^e^I^nc^om^e⁽^%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^e^s^t⁰¹¹⁸⁵²⁰⁰¹⁴¹³³²⁰⁰¹⁵¹³³²⁰⁰⁵⁵¹³³²⁰⁰
^t^Y^oung^e^s^t⁶¹⁸¹⁰⁰²⁰⁰⁶¹⁸¹⁰⁰²⁰⁰
ⁱ^{ki/CRS-RL32389}^e^r
^g/w^e^st
^s^.or^{c In}^co^m^e^Di^sregard^y^es^y^e^s^y^es^y^e^s
^le^ak^e^stsⁿ^oⁿ^oⁿ^oⁿ^o
^://wiki^Elig^ibility^(m^onths⁾^unde^r^a^g^e^{5: 12}^a^g^e^{5 a}^{nd up: 6}⁶¹²⁶
^h^ttp^s^um^ptiv^e^Elig^ibility^no^no^no^no
ⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿ^N^Aⁿ^oⁿ^oⁿ^o
^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no^y^e^s^b^ye^s^b^ye^s^b
^h^arin^g
^S^h^ariⁿ^{g Req}^uⁱ^red^N^A^y^es^y^e^s^y^es
^Sc^a^l^e^f^o^r^C^o^s^t^-^S^ha^rⁱ^ng^N^A^no^no^no
^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup
^ale^G^r^{oup D}^e^fⁱ^ne^d¹²³⁴¹²³⁴¹²³⁴¹²³⁴
^g^{e (%}^FP^L⁾¹³³¹⁰⁰¹⁰⁰²⁰⁰²⁰⁰²⁰⁰
^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d^m^onthly^m^onthly^m^onthly
ⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d^$¹⁵^$¹⁵^$¹⁵
^ily^C^a^p^$¹⁵^$¹⁵^$¹⁵
^y^m^e^nts

CRS-35
^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s^$3
^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s^$3
^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s^$3
^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s^$0
^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}^E^m^erg-Ro^o^m^$0
^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}^E^m^erg-Ro^o^m^$1⁰
^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^e^NA^S^ecret^ary^A^p^p^r^o^v^ed^S^ecret^ary^A^p^p^r^o^v^ed^Ex^isting^Com^p^re^he^nsiv^e
^S^t^at^e-Basedⁱ^oⁿ^N^A^S^am^{e as M}^e^dⁱ^cai^d^S^am^{e as M}^e^dⁱ^cai^d
^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^{d-Out (m}^onths)⁰⁰⁰⁰
^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no^no^no^no
^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r^Subs^idy^N^A^N^A^N^A^N^A
ⁱ^{ki/CRS-RL32389}^{e Ch}ⁱ^l^d^ren^’^{s M}^e^dⁱ^cal^S^e^rvi^{ces Net}^w^o^r^{k i}^s^f^o^{r ch}ⁱ^l^d^ren^wⁱ^t^h^sp^eci^al^h^eal^t^h^{care n}^eed^s.
^g/w^ha^{s a}^pprov^a^l^f^r^om^{CMS to im}^pose^a^c^a^p^{in its se}^pa^ra^te^st^a^t^e^prog^ra^m^if^{in a}^gⁱ^v^e^{n f}ⁱ^sc^a^l^y^e^a^r^the^sta^t^e^ha^{s utiliz}^e^d^a^ll^of^its^budg^e^t^e^d^f^unds^.

^s^.or
^le^ak
^://wiki
^h^ttp

^Pr^o^g^r^a^m^In^fo
^Sta^t^e^G^e^orgia.^Se^pa^ra^te^Sta^t^e^P^r^og^ra^m^Oⁿ^ly
^P^r^o^g^ram^Nam^e^P^each^{Care f}^o^{r Ki}^d^s
^T^y^p^e^Of^P^r^o^g^ram^S^ep^arat^{e S}^t^at^{e P}^r^o^g^ram
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^is^e^A^f^f^e^c^ting^{this P}^r^og^ra^mⁿ^o
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r^G^r^oups^N^o^{t Elig}^ible
^f^o^{r this P}^r^og^ra^mⁿ^o
^Eligib^ility
^A^g^e^I^nc^om^e⁽^%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t⁰¹¹⁸⁵²³⁵
^N^e^x^t^Y^oung^e^s^t¹⁵¹³³²³⁵
^O^l^de^r⁶¹⁸¹⁰⁰²³⁵
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregard^y^es
^A^{sset T}^e^stsⁿ^o
^Continuous^Elig^ibility^(m^onths⁾¹²
^P^r^e^s^um^ptiv^e^Elig^ibility^no
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿⁿ^o
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^y^es
^S^lⁱ^dⁱⁿ^{g S}^cal^{e f}^o^{r Co}^st^-S^h^a^riⁿ^g^age
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d^G^r^{oup 1}^a^G^r^{oup 2}^a^G^r^{oup 3}^G^r^{oup 4}
^Ran^g^{e (%}^FP^L⁾⁰⁶⁵¹⁸
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d^m^onthly
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d^$⁰^$⁷^.⁵⁰
^Fa^m^ily^Ca^p^$⁰^$¹⁵
^Co^-Pa^y^m^e^nts
^C^o^-^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s
^Co^-P^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}^E^m^erg-Ro^o^m
^Co^-P^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}^E^m^erg-Ro^o^m
^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^T^y^p^e^S^ecret^ary^A^p^p^r^o^v^ed
^O^p^tion^B^eⁿ^c^h^m^a^r^k^P^l^us^A^dditiona^l^b
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^{d-Out (m}^onths)³
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r^Subs^idy^N^A
^a.^G^A^b^a^{ses i}^t^s^slⁱ^dⁱⁿ^{g scal}^{e o}ⁿ^{age rat}^h^{er t}^h^anⁱⁿ^co^m^e^.
^{b. L}^a^r^g^e^s^{t H}^M^O^plus^a^dditiona^{l be}^ne^f^its^.

^Pr^o^g^r^a^m^In^fo
^Sta^t^e^Haw^a^ii.^Me^dic^aⁱ^{d Ex}^pa^ns^{ion O}ⁿ^ly
^P^r^og^r^a^m^N^a^m^e^Q^U^E^ST^a^{nd Me}^dic^aⁱ^{d FFS}
^T^y^pe^O^f^P^r^og^r^a^m^M^e^d^ic^aⁱ^{d Ex}^pa^ns^ion
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^ise^A^f^f^e^c^ting^this^ye^s^a
^Pr^o^g^r^a^m
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r
^G^r^oups^N^o^{t Elig}^ible^f^o^r^this^P^r^og^r^a^mⁿ^o
^Eligib^ility
^A^g^e^I^nc^om^e⁽^%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t⁰¹¹⁸⁵²⁰⁰
^N^e^x^t^Y^oung^e^s^t¹⁵¹³³²⁰⁰
^O^l^de^r⁶¹⁸¹⁰⁰²⁰⁰
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregard^y^es
^A^{sset T}^e^stsⁿ^o
^Continuous^Elig^ibility^(m^onths⁾⁰
^P^r^e^s^um^ptiv^e^Elig^ibility^no
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿ^N^A
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^N^A
^Slidⁱⁿ^g^{Scale f}^o^{r Co}^st-Sh^a^rin^g^NA
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d^G^r^{oup 1}^G^r^{oup 2}^G^r^{oup 3}^G^r^{oup 4}
^Ran^g^{e (%}^FP^L⁾
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d
^Fa^m^ily^Ca^p
^Co^-Pa^y^m^e^nts
^C^o^-^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s
^Co^-P^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}
^Em^e^r^g^-^R^oom
^Co^-P^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}
^Em^e^r^g^-^R^oom
^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^T^y^pe^C^o^m^p^r^e^he^ns^iv^e^Me^dic^aⁱ^{d Se}^c^{tion 1115 w}^a^iv^e^r
^Option^N^A
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^d-Out
⁽^m^onths⁾⁰
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r
^Subs^idy^N^A
^a^.^H^I^us^e^s^SC^H^I^P^f^unds^{to e}^x^pa^{nd Q}^U^E^ST^{, its}^c^o^m^p^r^e^he^ns^iv^e^Me^dic^aⁱ^{d Se}^c^{tion 1115 w}^a^iv^e^r^pr^og^r^a^m^.^C^h^ildr^eⁿ
^w^{ith dis}^a^bilitie^s^a^r^e^s^e^rv^e^d^throug^{h the}^Me^dic^aⁱ^{d f}^e^e^-^f^o^r-s^e^r^vⁱ^c^e^{(FFS) prog}^ra^m^.

^Pr^o^g^r^a^m^In^fo
^Sta^t^e^Idaho.^Me^dic^aⁱ^{d Ex}^pa^ns^{ion O}ⁿ^ly
^P^r^o^g^ram^Nam^e^Id^ah^o^CHIP
^T^y^pe^O^f^P^r^og^r^a^m^M^e^d^ic^aⁱ^{d Ex}^pa^ns^ion
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^ise^A^f^f^e^c^ting^this
^Pr^o^g^r^a^mⁿ^o
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r^G^r^oups^N^o^t
^Elig^ible^f^o^{r this P}^r^og^ra^mⁿ^o
^Eligib^ility
^A^g^e^I^nc^om^e⁽^%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t⁰⁵¹³³¹⁵⁰
^N^e^x^t^Y^oung^e^s^t⁶¹⁸¹⁰⁰¹⁵⁰
^Old^e^r
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregard^y^es
^A^{sset T}^e^sts^y^es
^Continuous^Elig^ibility^(m^onths⁾¹²
^P^r^e^s^um^ptiv^e^Elig^ibility^no
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿ^N^A
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^N^A
^Slidⁱⁿ^g^{Scale f}^o^{r Co}^st-Sh^a^rin^g^NA
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d^G^r^{oup 1}^G^r^{oup 2}^G^r^{oup 3}^G^r^{oup 4}
^Ran^g^{e (%}^FP^L⁾
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d
^Fa^m^ily^Ca^p
^Co^-Pa^y^m^e^nts
^C^o^-^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s
^Co^-P^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}^E^m^erg-Ro^o^m
^Co^-P^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}^E^m^erg-Ro^o^m
^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^Ty^p^e^N^A
^Option^N^A
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^{d-Out (m}^onths)⁰
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r^Subs^idy^N^A

CRS-39
^g^r^a^m^In^fo
^e^Illinois.^Com^b^ina^tion
^r^a^m^N^a^m^e^Kⁱ^dC^a^r^e^A^s^sⁱ^s^t^Ex^pa^ns^ion^K^idC^a^r^e^Sha^r^e^K^idC^a^r^e^P^r^e^m^ium
^e^Of^P^r^o^g^ram^M^edⁱ^cai^d^E^x^p^aⁿ^sⁱ^oⁿ^S^ep^arat^{e S}^t^at^{e P}^r^o^g^ram^S^ep^arat^{e S}^t^at^{e P}^r^o^g^ram
^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^iv^ing^P^r^ov^{isions Othe}^rw^ise^A^f^f^e^c^ting^this^a^a
^g^r^a^mⁿ^o^y^e^s^ye^s
ⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r^G^r^oups^N^o^t^a^a^a
^ible^f^o^{r this P}^r^og^ra^m^y^e^s^ye^s^ye^s
^ility
^A^g^e^I^nc^om^e⁽^%^FP^L⁾^A^g^e^I^nc^om^e⁽^%^FP^L⁾^A^g^e^I^nc^om^e⁽^%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^e^s^t⁶¹⁸¹⁰⁰¹³³⁰¹⁸¹³³¹⁵⁰⁰¹⁸¹⁵⁰¹⁸⁵
^t^Y^oung^e^s^t
ⁱ^{ki/CRS-RL32389}^e^r
^g/w^e^st
^s^.or^{c In}^co^m^e^Di^sregard^y^es^y^e^s^y^es
^le^ak^e^stsⁿ^oⁿ^oⁿ^o
^://wiki^Elig^ibility^(m^onths⁾¹²¹²¹²^s^um^ptiv^e^Elig^ibility^no^no^no
^h^ttpⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿ^N^A^y^e^s^b^ye^s^b
^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no^no^no
^h^arin^g
^arin^g^Req^uⁱ^red^N^A^y^es^y^e^s
^Sc^a^l^e^f^o^r^C^o^s^t^-^S^ha^rⁱ^ng^N^A^no^no
^ale^G^r^{oup D}^e^fⁱ^ne^d^G^r^{oup 1}^G^r^{oup 2}^G^r^{oup 3}^G^r^{oup 4}^G^r^{oup 1}^G^r^{oup 2}^G^r^{oup 3}^G^r^{oup 4}^G^r^{oup 1}^G^r^{oup 2}^G^r^{oup 3}^G^r^{oup 4}
^g^{e (%}^FP^L⁾¹³³¹⁵⁰¹⁵⁰¹⁸⁵
^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d^no^m^onthly
ⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d^$1⁵
^ily^Ca^p^$3⁰
^y^m^e^nts
^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s^$²^$⁵
^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s^$²^$³

CRS-40
^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s^$²^$⁵
^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s^$⁰^$⁰
^mⁱ^ssin^g
^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}^E^m^erg-Ro^o^m^$²^inf^o
^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}^E^m^erg-Ro^o^m^$²^$²⁵
^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^N^A^B^e^nc^hm^a^r^k^Equiv^a^le^nt^B^e^nc^hm^a^r^k^Equiv^a^le^nt
^N^A^S^ta^te^Em^ploy^e^e^Sta^t^e^Em^ploy^e^e
^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^{d-Out (m}^onths)⁰⁰⁰
^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no^y^e^s^a^ye^s^a
^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r^Subs^idy^N^A^aa
^’^H^I^FA^w^a^iv^e^r^a^llow^s^the^s^t^a^t^e^{to us}^e^Me^dic^aⁱ^{d a}^{nd SC}^H^I^P^f^unds^{to c}^o^v^e^r^pa^r^e^nts^of^Me^dic^aⁱ^{d a}^{nd SC}^H^I^P^c^h^ildr^e^n.^Th^e^d^e^m^oⁿ^s^t^r^atⁱ^oⁿ^al^s^o^p^r^ov^ide^s^T^itle^X^X^I^f^unding^f^o^{r the}^Illinois
ⁱ^{ki/CRS-RL32389}^Com^p^re^he^ns^iv^e^H^e^a^{lth Ins}^u^ra^nc^e^P^r^og^ra^m^a^{nd he}^m^ophilia^c^s^{(both pre}^v^ious^ly^s^t^a^t^e^-^f^unde^{d prog}^ra^m^s^{). Illinois}^’^w^a^iv^e^r^a^l^s^o^a^llow^s^t^h^e^st^at^e^t^o^p^r^o^vⁱ^d^e^a^su^b^sⁱ^d^y^f^o^{r E}^S^{I t}^h^at^can⁽¹^{) o}^f^f^e^{r a}^red^u^ced^b^eⁿ^e^fⁱ^t^s^p^{ackage (h}^o^w^ever,^t^h^{e st}^at^{e m}^u^st^en^su^{re t}^h^at^al^l^age-ap^p^r^o^p^rⁱ^a^t^eⁱ^m^m^uⁿⁱ^zatⁱ^oⁿ^s^{are co}^vered⁾^,^an^d⁽²^{) i}^m^p^o^s^{e co}^st^-sh^a^rⁱⁿ^g^t^h^at^exceed^{s t}^h^{e aggregat}^e,^a^nnua^{l 5%}^of^f^a^m^ily^inc^o^m^e^lim^ita^tion
^g/wⁱⁿ^t^h^e^S^C^H^I^P^s^t^a^t^u^t^e.^T^h^{e t}^e^rm^{s an}^d^coⁿ^dⁱ^tⁱ^oⁿ^s^o^f^t^h^{e w}^aⁱ^v^{er p}^r^o^s^cri^b^{e t}^h^at^en^ro^l^l^m^en^tⁱⁿ^E^S^{I i}^s^vo^l^uⁿ^t^ary^an^d^t^h^at^t^h^{e st}^at^e^m^u^s^t^inf^o^r^m^eⁿ^r^o^lle^e^s^of^the^im^plic^a^tions^of^c^hoosⁱⁿ^g^p^rⁱ^v^at^e^o^r
^s^.or^e^m^ploy^e^r^-^s^pons^or^e^d^ins^u^r^a^nc^e^.^T^h^e^w^a^iv^e^r^a^l^s^o^w^a^iv^e^s^the^mⁱ^nim^u^m^e^m^ploy^e^r^c^ontrⁱ^{bution r}^e^quir^e^m^e^nt.
^le^ak^of^f^e^rs^preⁿ^a^t^a^l^c^a^r^e^f^r^om^c^onf^irm^a^{tion of}^pre^g^na^nc^y^throug^{h birth to pre}^g^na^{nt w}^o^m^e^{n in f}^a^m^ilie^s^w^{ith inc}^o^m^e^{up to 200%}^FP^L.

^://wiki
^h^ttp

^Pr^o^g^r^a^m^In^fo
^Sta^t^e^Indiana.^Com^b^ina^tion
^P^r^o^g^ram^Nam^e^Ho^o^sⁱ^e^{r Heal}^t^h^wⁱ^{se P}^h^{ase I}^H^o^o^sⁱ^e^{r Heal}^t^h^wⁱ^{se P}^h^{ase II}
^T^y^p^e^Of^P^r^o^g^ram^M^edⁱ^cai^d^E^x^p^aⁿ^sⁱ^oⁿ^S^ep^arat^{e S}^t^at^{e P}^r^o^g^ram
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^ise^A^f^f^e^c^ting
^{this P}^r^og^ra^mⁿ^oⁿ^o
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r
^G^r^oups^N^o^{t Elig}^ible^f^o^r^this^P^r^og^r^a^mⁿ^oⁿ^o
^Eligib^ility
^In^co^m^e
^Ag^e⁽^%^FP^L⁾^A^g^e^I^nc^om^e⁽^%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t¹⁵¹³³¹⁵⁰⁰¹⁸¹⁵⁰²⁰⁰
^N^e^x^t^Y^oung^e^s^t⁶¹⁸¹⁰⁰¹⁵⁰
^Old^e^r
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregard^y^es^y^e^s
^A^{sset T}^e^stsⁿ^oⁿ^o
^Continuous^Elig^ibility^(m^onths⁾⁰¹²
^P^r^e^s^um^ptiv^e^Elig^ibility^no^no
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿ^N^Aⁿ^o
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no^no
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^N^A^y^es
^Sliding^Sc^a^l^e^f^o^{r Cost-Sha}^ring^NA^inc^o^m^e
^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d¹²³⁴¹²³⁴
^Ran^g^{e (%}^FP^L⁾¹⁵⁰¹⁷⁵¹⁷⁵²⁰⁰
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d^m^onthly
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d^$¹¹^$¹⁶^.⁵⁰
^Fa^m^ily^C^a^p^$^16.50^$^24.75
^Co^-Pa^y^m^e^nts
^C^o^-^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s^$¹⁰^$¹⁰
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s^$³^$³
^Co^-P^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s^$⁰^$⁰
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}
^Em^e^r^g^-^R^oom^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}
^Em^e^r^g^-^R^oom^$⁰^$⁰
^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^T^y^pe^N^A^B^e^nc^hm^a^r^k^Equiv^a^le^nt
^Option^N^A^F^EHBP
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^d-Out
⁽^m^onths⁾⁰³
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no^no
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^d
^f^o^r^Subs^idy^N^A^N^A

^Pr^o^g^r^a^m^In^fo
^Sta^t^e^Iow^a^.^Com^b^ina^tion
^He^a^lthy^W^e^{ll Kids Iow}^a
^P^r^o^g^r^a^{m N}^a^me^M^e^dⁱ^c^aⁱ^d^(HA^W^K-I)
^T^y^p^e^Of^P^r^o^g^ram^M^edⁱ^cai^d^E^x^p^aⁿ^sⁱ^oⁿ^S^ep^arat^{e S}^t^at^{e P}^r^o^g^ram
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^ise^A^f^f^e^c^ting^this
^Pr^o^g^r^a^mⁿ^oⁿ^o
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r
^G^r^oups^N^o^{t Elig}^ible^f^o^r^this^P^r^og^r^a^mⁿ^oⁿ^o
^Eligib^ility
^In^co^m^e^In^co^m^e
^Ag^e^(%^FP^L⁾^A^g^e^(%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t⁰¹¹⁸⁵²⁰⁰¹¹⁸¹³³²⁰⁰
^N^e^x^t^Y^oung^e^s^t⁶¹⁸¹⁰⁰¹³³
^Old^e^r
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregard^y^es^y^e^s
^A^{sset T}^e^stsⁿ^oⁿ^o
^Continuous^Elig^ibility^(m^onths⁾⁰¹²
^P^r^e^s^um^ptiv^e^Elig^ibility^no^no
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿ^N^Aⁿ^o
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no^no
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^N^A^y^es
^Sliding^Sc^a^l^e^f^o^{r Cost-Sha}^ring^NA^inc^o^m^e
^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d¹²³⁴¹²³⁴
^Ran^g^{e (%}^FP^L⁾¹³³¹⁵⁰¹⁵⁰²⁰⁰
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d^m^onthly
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d^$⁰^$¹⁰
^Fa^m^ily^Ca^p^$⁰^$²⁰
^Co^-Pa^y^m^e^nts
^C^o^-^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s^$⁰^$⁰
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}
^Em^e^r^g^-^R^oom^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}
^Em^e^r^g^-^R^oom^$⁰^$²⁵
^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^T^y^pe^N^A^B^e^nc^hm^a^r^k^Equiv^a^le^nt
^Option^N^A^S^ta^te^Em^ploy^e^e
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^d-Out
⁽^m^onths⁾⁰⁶
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no^no
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r
^Subs^idy^N^A^N^A

^Pr^o^g^r^a^m^In^fo
^Sta^t^e^K^a^nsas.^Se^pa^ra^te^Sta^t^e^P^r^og^ra^m^Oⁿ^ly
^P^r^o^g^r^a^{m N}^a^me^H^e^a^l^t^h^W^a^v^e
^T^y^p^e^Of^P^r^o^g^ram^S^ep^arat^{e S}^t^at^{e P}^r^o^g^ram
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^ise^A^f^f^e^c^ting^this
^Pr^o^g^r^a^mⁿ^o
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r^G^r^oups^N^o^t
^Elig^ible^f^o^{r this P}^r^og^ra^mⁿ^o
^Eligib^ility
^A^g^e^I^nc^om^e⁽^%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t⁰¹¹⁵⁰²⁰⁰
^N^e^x^t^Y^oung^e^s^t¹⁵¹³³²⁰⁰
^O^l^de^r⁶¹⁸¹⁰⁰²⁰⁰
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregard^y^es
^A^{sset T}^e^stsⁿ^o
^Continuous^Elig^ibility^(m^onths⁾¹²
^P^r^e^s^um^ptiv^e^Elig^ibility^no
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿⁿ^o
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^y^es
^Sliding^Sc^a^l^e^f^o^{r Cost-Sha}^ring^inc^o^m^e
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d^G^r^{oup 1}^G^r^{oup 2}^G^r^{oup 3}^G^r^{oup 4}
^Ran^g^{e (%}^FP^L⁾¹⁵⁰¹⁷⁵¹⁷⁵²⁰⁰
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d^m^onthly
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d^$¹⁰^$¹⁵
^Fa^m^ily^Ca^p^$¹⁰^$¹⁵
^Co^-Pa^y^m^e^nts
^C^o^-^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s^$⁰^$⁰
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}^E^m^erg-Ro^o^m^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}^E^m^erg-Ro^o^m^$⁰^$⁰
^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^T^y^p^e^S^ecret^ary^A^p^p^r^o^v^ed
^O^p^tion^B^eⁿ^c^h^m^a^r^k^P^l^us^A^dditiona^l^a
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^{d-Out (m}^onths)⁰
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r^Subs^idy^N^A
^a^.^Sta^t^e^e^m^ploy^e^e^plaⁿ^plus^de^nta^l^a^{nd m}^e^nta^l^he^a^lth.

^Pr^o^g^r^a^m^In^fo
^Sta^t^e^Kentucky^.^Com^b^ina^tion
^KCHIP^Sep^a^{rate In}^su^ran^c^e
^P^r^og^r^a^m^N^a^m^e^K^C^H^I^P^Me^dic^aⁱ^{d Ex}^pa^ns^ion^Pr^o^g^r^a^m
^T^y^p^e^Of^P^r^o^g^ram^M^edⁱ^cai^d^E^x^p^aⁿ^sⁱ^oⁿ^S^ep^arat^{e S}^t^at^{e P}^r^o^g^ram
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^ise^A^f^f^e^c^ting^this
^Pr^o^g^r^a^mⁿ^oⁿ^o
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r
^G^r^oups^N^o^{t Elig}^ible^f^o^r^this^P^r^og^r^a^mⁿ^oⁿ^o
^Eligib^ility
^In^co^m^e^In^co^m^e
^Ag^e^(%^FP^L⁾^A^g^e^(%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t¹⁵¹³³¹⁵⁰⁰¹¹⁸⁵²⁰⁰
^N^e^x^t^Y^oung^e^s^t⁶¹⁸¹⁰⁰¹⁵⁰¹¹⁸¹⁵⁰²⁰⁰
^Old^e^r
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregard^y^es^y^e^s
^A^{sset T}^e^stsⁿ^oⁿ^o
^Continuous^Elig^ibility^(m^onths⁾⁰^a⁰
^P^r^e^s^um^ptiv^e^Elig^ibility^no^no
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿ^N^Aⁿ^o
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no^no
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^y^es^b^ye^s^b
^S^lⁱ^dⁱⁿ^{g S}^cal^{e f}^o^{r Co}^st^-S^h^a^riⁿ^g^age^b^age^b
^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d¹²³⁴¹²³⁴
^Ran^g^{e (%}^FP^L⁾⁰¹⁸⁰¹⁸¹⁷¹⁸¹⁷¹⁸
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d^no^no
^P^r^e^mⁱ^u^m^/^F^e^P^e^r^C^hⁱ^l^d^$⁰^$0^$0^$0
^F^a^mⁱ^l^y^C^a^p^$^0$⁰^$^0$⁰
^Co^-Pa^y^m^e^nts
^C^o^-^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s^$⁰^$¹^$⁰^$¹
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s^$⁰^$¹^$⁰^$¹
^C^o^-^P^a^y^m^eⁿ^t^F^o^r^O^fⁱ^c^e^Vⁱ^sⁱ^t^s^$⁰^$0^$0^$0
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s^$⁰^$⁰^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}^E^m^erg-Ro^o^m^$⁰^$⁰^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}
^E^m^e^r^g^-^R^o^m^$⁰^$0^$0^$0
^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^T^y^p^e^NA^S^ecret^ary^A^p^p^r^o^v^ed
^O^p^tion^N^A^B^eⁿ^c^h^m^a^r^k^P^l^us^A^dditiona^l^c
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^d-Out
⁽^m^onths⁾⁰⁶
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no^no
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r
^Subs^idy^N^A^N^A
^a^.^C^h^ildr^e^{n liv}^ing^{in r}^e^gⁱ^ons^c^o^v^e^r^e^{d by}^K^e^ntuc^k^y^’^s^s^ub-^s^t^a^t^e^H^e^a^{lth C}^a^r^e^P^a^r^t^ne^r^s^{hip Se}^c^{tion 1115}^w^aⁱ^v^e^r
^recei^{ve si}^{x m}^oⁿ^t^h^s^coⁿ^tⁱ^nuous^e^lig^ibility^.

^{b. K}^Y^c^h^a^r^g^e^s^18-^y^e^a^r^olds^a^{$1 c}^o^-^p^a^y^f^o^r^pha^r^m^a^c^y^pr^e^s^c^r^iptions^,^w^h^ic^h^is^the^s^a^m^e^c^o^s^t^-^s^ha^rⁱ^ng^r^e^quir^e^m^e^nt
^tha^t^{is im}^pose^d^throug^{h the}^sta^t^e^’^{s T}^itle^X^I^X^sta^t^e^plaⁿ^.
^c^.^Sta^t^e^e^m^ploy^e^e^plus^a^dditiona^{l be}^ne^f^its^.

^Pr^o^g^r^a^m^In^fo
^Sta^t^e^Louisiana.^Me^dic^aⁱ^{d Ex}^pa^ns^{ion O}ⁿ^ly
^P^r^o^g^r^a^{m N}^a^me^L^a^C^H^I^P
^T^y^pe^O^f^P^r^og^r^a^m^M^e^d^ic^aⁱ^{d Ex}^pa^ns^ion
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^ise^A^f^f^e^c^ting^this
^Pr^o^g^r^a^mⁿ^o
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r^G^r^oups^N^o^t
^Elig^ible^f^o^{r this P}^r^og^ra^mⁿ^o
^Eligib^ility
^A^g^e^I^nc^om^e⁽^%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t⁰⁵¹³³²⁰⁰
^N^e^x^t^Y^oung^e^s^t⁶¹⁸¹⁰⁰²⁰⁰
^Old^e^r
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregard^y^es
^A^{sset T}^e^stsⁿ^o
^Continuous^Elig^ibility^(m^onths⁾¹²
^P^r^e^s^um^ptiv^e^Elig^ibility^no
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿ^N^A
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^N^A
^Slidⁱⁿ^g^{Scale f}^o^{r Co}^st-Sh^a^rin^g^NA
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d^G^r^{oup 1}^G^r^{oup 2}^G^r^{oup 3}^G^r^{oup 4}
^Ran^g^{e (%}^FP^L⁾
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d
^Fa^m^ily^Ca^p
^Co^-Pa^y^m^e^nts
^C^o^-^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s
^Co^-P^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}^E^m^erg-Ro^o^m
^Co^-P^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}^E^m^erg-Ro^o^m
^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^Ty^p^e^N^A
^Option^N^A
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^{d-Out (m}^onths)⁰
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r^Subs^idy^N^A

^P^r^o^g^ram^In^f^o
^Sta^t^e^Maine.^Com^b^ina^tion
^P^r^o^g^ram^Nam^e^M^aⁱⁿ^eCare^M^aiⁿ^e^Care
^T^y^p^e^Of^P^r^o^g^ram^M^edⁱ^cai^d^E^x^p^aⁿ^sⁱ^oⁿ^S^ep^arat^{e S}^t^at^{e P}^r^o^g^ram
^Sta^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^ise^A^f^f^e^c^ting^this
^Pr^o^g^r^a^mⁿ^oⁿ^o
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r
^G^r^oups^N^o^{t Elig}^ible^f^o^r^this^P^r^og^r^a^mⁿ^oⁿ^o
^Elig^ibility
^In^co^m^e^In^co^m^e
^Ag^e^(%^FP^L⁾^A^g^e^(%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t¹⁵¹³³¹⁵⁰⁰¹¹⁸⁵²⁰⁰
^N^e^x^t^Y^oung^e^s^t⁶¹⁸¹²⁵¹⁵⁰¹¹⁸¹⁵⁰²⁰⁰
^Old^e^r
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregard^y^esⁿ^o
^A^{sset T}^e^stsⁿ^oⁿ^o
^Continuous^Elig^ibility^(m^onths⁾¹²¹²
^P^r^e^s^um^ptiv^e^Elig^ibility^no^no
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿ^N^Aⁿ^o
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no^no
^Co^{st Sh}^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^N^A^y^es
^Sliding^Sc^a^l^e^f^o^{r Cost-Sha}^ring^NA^inc^o^m^e
^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup
^{Sliding Sc}^ale^G^r^{oup D}^e^fine^d¹²³⁴¹²³⁴
^Ran^g^{e (%}^FP^L⁾¹⁵⁰¹⁶⁰¹⁷⁰¹⁸⁵¹⁶⁰¹⁷⁰¹⁸⁵²⁰⁰
^Pre^m^{ium or Enrollme}ⁿ^{t Fe}^e^Re^quire^d^m^onthly
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d^$⁵^$¹⁰^$¹⁵^$²⁰
^Fa^m^ily^C^a^p^$¹⁰^$²⁰^$³⁰^$⁴⁰
^C^o^-^P^ay^m^e^nts
^C^o^-^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s^$⁰^$⁰^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s^$⁰^$⁰^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s^$⁰^$⁰^$⁰^$⁰
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s^$⁰^$⁰^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}^E^m^erg-Ro^o^m^$⁰^$⁰^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}
^E^m^e^r^g^-^R^o^m^$⁰^$0^$0^$⁰
^Cov^e^ra^g^e^T^y^pe^/Option
^T^y^p^e^NA^S^ecret^ary^A^p^p^r^o^v^ed
^Op^tⁱ^oⁿ^N^A^S^am^{e as M}^e^dⁱ^cai^d
^R^e^la^tions^{hip T}^o^P^r^iv^a^t^e^/^O^t^he^r^C^o^v^e^r^a^g^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^d-Out
⁽^m^onths⁾⁰³
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no^no
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r
^Subs^idy^N^A^N^A

^Pr^o^g^r^a^m^In^fo
^Sta^t^e^Mary^land.^Com^b^ina^tion
^Ma^ry^la^{nd Childre}^{n’s He}^a^lth^Ma^ry^la^{nd Childre}^{n’s He}^a^lth
^P^r^o^g^r^a^{m N}^a^me^P^r^o^g^ram^(I)^P^r^o^g^ram^(II)
^T^y^p^e^Of^P^r^o^g^ram^M^edⁱ^cai^d^E^x^p^aⁿ^sⁱ^oⁿ^S^ep^arat^{e S}^t^at^{e P}^r^o^g^ram
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^ise^A^f^f^e^c^ting^this^a
^Pr^o^g^r^a^m^y^e^s^no
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r
^G^r^oups^N^o^{t Elig}^ible^f^o^r^this^P^r^og^r^a^mⁿ^oⁿ^o
^Eligib^ility
^In^co^m^e
^Ag^e⁽^%^FP^L⁾^A^g^e^I^nc^om^e⁽^%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t⁰¹¹⁸⁵²⁰⁰⁰¹⁸²⁰⁰³⁰⁰
^N^e^x^t^Y^oung^e^s^t¹⁵¹³³²⁰⁰
^O^l^de^r⁶¹⁸¹⁰⁰²⁰⁰
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregard^y^es^y^e^s
^A^{sset T}^e^stsⁿ^oⁿ^o
^Continuous^Elig^ibility^(m^onths⁾⁶¹²
^P^r^e^s^um^ptiv^e^Elig^ibility^no^no
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿ^N^Aⁿ^o
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no^no
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^N^A^y^es
^Sliding^Sc^a^l^e^f^o^{r Cost-Sha}^ring^NA^inc^o^m^e
^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d¹²³⁴¹²³⁴
^Ran^g^{e (%}^FP^L⁾²⁰⁰²⁵⁰²⁵⁰³⁰⁰
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d^m^onthly
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d^$⁴⁰^$⁵⁰
^Fa^m^ily^Ca^p^$⁴⁰^$⁵⁰
^Co^-Pa^y^m^e^nts
^C^o^-^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s^$⁰^$⁰
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}^E^m^erg-Ro^o^m^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}
^E^m^e^r^g^-^R^o^m^$0^$0
^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^T^y^p^e^NA^S^ecret^ary^A^p^p^r^o^v^ed
^Op^tⁱ^oⁿ^N^A^S^am^{e as M}^e^dⁱ^cai^d
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^d-Out^a
⁽^m^onths⁾⁶⁶
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no^y^e^s^b
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r
^Subs^idy^N^A^30%
^a^.^MD^ha^s^a^Se^c^{tion 1115}^w^a^iv^e^r^a^llowⁱ^ng^a^sⁱ^x^-^m^onth^w^a^iting^pe^{riod prior to e}ⁿ^rollm^eⁿ^{t in the}^s^t^a^t^e^’^s^SCH^I^P
^Me^dic^aⁱ^{d Ex}^pa^ns^{ion pr}^og^r^a^m^.

^{b. For}^Em^ploy^e^r^Spons^or^e^d^Iⁿ^s^u^r^a^nc^e⁽^E^SI⁾^to^qua^lif^y^f^o^r^a^s^ubs^idy^thr^oug^{h the}^s^t^a^t^e^’^s^s^e^pa^r^a^te^s^t^a^t^e^pr^og^r^a^m^,
^{a p}^l^an^o^f^f^e^red^b^y^sm^al^l^em^p^l^o^y^ers^m^u^st^u^s^{e t}^h^{e st}^at^{e’s l}^a^rgest^HM^{O as a b}^eⁿ^c^h^m^ark.^A^p^l^an^o^f^f^e^red^b^y
^la^r^g^e^e^m^ploy^e^r^s^m^u^s^t^e^ithe^r^be⁽¹⁾^the^be^nc^hm^a^r^k^-^e^quiv^a^le^{nt of}^the^st^at^e’^s^l^a^r^g^e^s^{t H}^M^O^,^or⁽²⁾
^substa^ntia^lly^e^quiv^a^le^{nt to or g}^r^e^a^t^e^r^thaⁿ^the^sta^t^e^’^s^la^r^g^e^s^{t H}^M^O^thr^oug^{h a}^be^ne^f^it^by^be^ne^f^it^c^o^m^p^a^r^is^on
^(S^ecret^ary^-^A^p^p^r^o^v^ed^co^verage).^A^chⁱ^l^d^w^h^o^h^a^{s access t}^o^q^u^a^lⁱ^f^yⁱⁿ^g^E^S^{I i}^s^req^uⁱ^red^t^o^en^ro^l^lⁱⁿ^E^S^Iⁱ^f
^the^e^m^ploy^e^d^pa^r^e^{nt is}^a^l^r^e^a^d^y^eⁿ^r^o^lle^{d in ESI}^f^o^r^him^-^or^he^r^s^e^l^f^.^I^f^the^pa^r^e^{nt is}^not^a^l^r^e^a^d^y^eⁿ^r^o^lle^dⁱⁿ
^{ESI, it is the}^f^a^m^ily^{’s c}^hoic^e^w^h^e^t^he^{r to e}ⁿ^{roll in}^E^S^{I o}^rⁱⁿ^t^h^{e st}^at^{e’s sep}^a^rat^e^st^at^{e p}^r^o^g^ram^.

CRS-50
^g^r^a^m^In^fo
^e^{Massachusetts.}^Com^b^ina^tion
^M^a^ssHealth^F^a^m^ily^A^{ssist Direct}
^ra^m^Na^m^e^Ma^ssHe^a^{lth Sta}^nda^rd^Ma^ssHe^a^{lth Com}^m^onHe^a^lth^a^Co^{verage (DC)}^M^a^ssHealth^P^r^em^iu^m^A^ssistan^ce
^e^Of^P^r^o^g^ram^M^edⁱ^cai^d^E^x^p^aⁿ^sⁱ^oⁿ^S^ep^arat^{e S}^t^at^{e P}^r^o^g^ram^S^ep^arat^{e S}^t^at^{e P}^r^o^g^ram^S^ep^arat^{e S}^t^at^{e P}^r^o^g^ram
^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^iv^ing^P^r^ov^{isions Othe}^rw^ise^A^f^f^e^c^ting^this
^g^r^a^mⁿ^oⁿ^oⁿ^oⁿ^o
ⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r^G^r^oups^N^o^t
^ible^f^o^{r this P}^r^og^ra^mⁿ^oⁿ^oⁿ^oⁿ^o
^ility
^In^co^m^e^In^co^m^e
^Ag^e^(%^FP^L⁾^A^g^e⁽^%^FP^L⁾^A^g^e^I^nc^om^e⁽^%^FP^L⁾^A^g^e^I^nc^om^e⁽^%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
ⁱ^{ki/CRS-RL32389}^e^s^t⁰¹¹⁸⁵²⁰⁰¹¹⁸¹⁵⁰²⁰⁰¹¹⁸¹⁵⁰²⁰⁰¹¹⁸¹⁵⁰²⁰⁰^t^Y^oung^e^s^t¹⁵¹³³¹⁵⁰
^g/w^r⁶¹⁴¹¹⁵¹⁵⁰
^s^.or
^le^ak^s^t¹⁵¹⁸¹⁰⁰¹⁵⁰
^{c In}^co^m^e^Di^sregardⁿ^oⁿ^oⁿ^oⁿ^o
^://wiki^e^stsⁿ^oⁿ^oⁿ^oⁿ^o
^h^ttp^Elig^ibility^(m^onths⁾⁰⁰⁰⁰
^s^um^ptiv^e^Elig^ibility^y^e^sⁿ^o^y^e^s^no
ⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿ^N^Aⁿ^oⁿ^oⁿ^o
^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no^no^no^no
^h^arin^g
^S^h^ariⁿ^{g Req}^uⁱ^red^N^A^y^es^y^e^s^y^es
^Sc^a^l^e^f^o^r^C^o^s^t^-^S^ha^rⁱ^ng^N^A^inc^o^m^e^no^no
^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup
^ale^G^r^{oup D}^e^fⁱ^ne^d¹²³⁴¹²³⁴⁵¹²³⁴¹²³⁴
^g^{e (%}^FP^L⁾¹⁵⁰¹⁶⁰¹⁷⁰¹⁸⁰¹⁹⁰¹⁵⁰¹⁵⁰¹⁶⁰¹⁷⁰¹⁸⁰¹⁹⁰²⁰⁰²⁰⁰²⁰⁰
^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d^m^onthly^m^onthly^m^onthly
^m^ium^/^Fe^e^P^e^r^C^h^ild^$¹⁵^$²⁰^$²⁵^$³⁰^$³⁵^$¹²^$¹²
^ily^C^a^p^$¹⁵^$²⁰^$²⁵^$³⁰^$³⁵^$³⁶^$³⁶

CRS-51
^y^m^e^nts
^P^a^y^m^eⁿ^t^F^o^r^B^r^aⁿ^d^N^a^m^e^R^x^D^r^u^g^s^$^0$^0$^0$^0$⁰^$⁰^b
^P^a^y^m^eⁿ^t^F^o^r^G^eⁿ^e^rⁱ^c^R^x^D^r^u^g^s^$^0$^0$^0$^0$⁰^$⁰^b
^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s^$⁰^$⁰^$⁰^$⁰^$⁰^$⁰^b
^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s^$⁰^$⁰^$⁰^$⁰^$⁰^$⁰^b
^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}^E^m^erg-Ro^o^m^$⁰^$⁰^$⁰^$⁰^$⁰^$⁰^b
^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}^E^m^erg-Ro^o^m^$⁰^$⁰^$⁰^$⁰^$⁰^$⁰^b
^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^e^NA^Ben^c^h^m^ark^B^en^ch^m^a^rk^S^ecret^ary^A^p^p^r^o^v^ed
^C^o^m^p^r^e^he^ns^iv^e^Me^dic^aⁱ^{d Se}^c^tion
ⁿ^N^A^L^{argest HM}^O^L^{argest HM}^O^{1115 W}^a^iv^e^r
^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^{d-Out (m}^onths)⁰⁰⁰⁰
^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no^no^c^no^c^ye^s^c
ⁱ^{ki/CRS-RL32389}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r^Subs^idy^N^A^N^A^N^A^50%
^g/w
^s^.or^e^C^o^m^m^onH^e^a^{lth P}^r^og^r^a^m^is^f^o^r^c^h^ildr^e^{n w}^{ho a}^r^e^pe^r^m^aⁿ^eⁿ^tly^a^nd^tota^lly^dis^a^ble^d^a^nd^pr^ov^ide^s^be^ne^f^its^tha^t^a^r^e^c^o^m^m^onⁱⁿ^M^e^d^ic^aⁱ^{d but not ne}^c^e^s^s^a^r^ily^{in s}^e^pa^r^a^te^s^t^a^t^e^pr^og^r^a^m^s^{, s}^u^c^h^a^s^nur^sⁱ^ng
^le^ak^hom^e^a^{nd pe}^r^s^ona^{l c}^a^r^e^.
^ploy^e^r^s^pons^ore^d^ins^u^ra^nc^e^c^aⁿ^c^h^a^r^g^e^c^opa^y^s^,^c^o^ins^u^ra^nc^e^,^a^{nd de}^duc^tible^s^.^T^h^e^s^t^a^t^e^w^{ill pa}^y^the^s^e^a^m^ounts^f^o^{r c}^h^ildreⁿ^elⁱ^gⁱ^b^l^e^f^o^{r p}^r^emⁱ^u^m^assi^st^an^{ce p}^r^o^vⁱ^d^ed^:⁽¹^{) t}^h^{e co}^p^a^y^,^coⁱⁿ^su^ran^{ce o}^r
^://wiki^de^duc^tible^w^a^s^inc^u^rre^{d a}^s^the^re^s^u^{lt of}^a^w^e^ll-ba^by^/w^e^ll-c^h^ild^c^a^r^e^vⁱ^s^{it; or (2) the}^polic^y^holde^r’s^a^nnua^liz^e^d^s^h^a^r^e^of^the^e^m^p^loy^e^r^-^s^pons^or^e^d^he^a^{lth ins}^u^r^a^nc^e^pr^e^m^ium^s^{, c}^o^m^b^ine^d^w^{ith c}^opa^y^s^,^coⁱⁿ^su^ran^ce,^an^d^d^e^d^u^c^tⁱ^b^l^e^{s i}ⁿ^cu^rred^an^d^p^aⁱ^d^b^y^m^e^m^b^ers,^exceed^{s 5}^%^o^f^t^h^{e f}^a^mⁱ^l^y^gr^oup’^s^g^r^os^s^inc^o^m^e^{in a}^12-m^{onth pe}^{riod be}^gⁱ^nning^w^{ith the}^da^te^of^e^lig^ibility^f^o^{r pre}^m^ium^a^s^sⁱ^s^t^aⁿ^c^e^.
^h^ttp^M^e^m^b^{ers receiv}^e^anⁱⁿ^{itial n}^o^{tice at th}^{e tim}^{e o}^f^elig^ib^ility^ex^p^l^ainⁱⁿ^g^th^{e state’s p}^o^licy^oⁿ^p^a^y^m^en^{t o}^f^co^p^a^y^s^{, co}ⁱⁿ^su^ran^{ce an}^{d de}^duc^tible^{s. P}^r^ov^ide^r^{s m}^a^y^{bill the}^sta^t^e^dire^c^tly^{or m}^e^m^b^e^r^{s m}^a^y
^{seek rei}^m^b^u^r^sem^eⁿ^t^f^r^o^m^t^h^{e st}^at^e.
^h^ildr^e^{n e}^lig^ible^f^o^r^Fa^m^ily^A^s^sⁱ^s^t^D^C^a^r^e^r^e^quir^e^{d to e}ⁿ^r^o^llⁱⁿ^e^m^ploy^e^r^s^pons^or^e^d^c^o^v^e^r^a^g^e^thr^oug^h^the^P^r^e^m^ium^A^s^sⁱ^s^t^aⁿ^c^e^p^r^o^g^ramⁱ^f^t^h^ei^{r f}^a^mⁱ^l^y^h^a^{s access t}^o^{a q}^u^a^lⁱ^fⁱ^e^d^p^l^an^.^Chⁱ^l^d^ren^elⁱ^gⁱ^b^l^e
^f^o^r^C^o^m^m^onH^e^a^{lth ha}^v^e^the^{option to e}ⁿ^r^o^{ll in e}^m^ploy^e^r^s^pons^or^e^d^c^o^v^e^r^a^g^e^thr^oug^{h the}^P^r^e^m^ium^A^s^sⁱ^s^t^aⁿ^c^e^pr^og^r^a^m^if^theⁱ^r^f^a^mⁱ^l^y^h^a^{s access t}^o^{a q}^u^a^lⁱ^fⁱ^e^d^p^l^an^.
^:^MA^a^l^s^o^c^o^v^e^r^s^pr^e^g^na^{nt a}^dole^s^c^eⁿ^ts^w^{ith s}^e^lf^-^d^e^c^l^a^r^e^d^inc^o^m^e^be^tw^e^eⁿ^185-^200%^FP^L^f^o^r^w^h^ic^{h the}^unbor^{n c}^h^ild(^r^eⁿ⁾^a^r^e^c^ount^e^d^a^s^if^{born in de}^te^rm^ining^f^a^m^ily^siz^e^f^o^r^the^purpose^of^e^v^a^l^ua^ting
^m^e^e^lig^ibility^.

^Pr^o^g^r^a^m^In^fo
^Sta^t^e^Michigan.^Com^b^ina^tion
^P^r^og^ra^m^Na^m^e^He^a^lthy^Kids^MIChild
^T^y^p^e^Of^P^r^o^g^ram^M^edⁱ^cai^d^E^x^p^aⁿ^sⁱ^oⁿ^S^ep^arat^{e S}^t^at^{e P}^r^o^g^ram
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^ise^A^f^f^e^c^ting^this
^Pr^o^g^r^a^mⁿ^oⁿ^o
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r
^G^r^oups^N^o^{t Elig}^ible^f^o^r^this^P^r^og^r^a^mⁿ^oⁿ^o
^Eligib^ility
^In^co^m^e^In^co^m^e
^Ag^e^(%^FP^L⁾^A^g^e^(%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t¹⁶¹⁸¹⁰⁰¹⁵⁰⁰¹¹⁸⁵²⁰⁰
^N^e^x^t^Y^oung^e^s^t¹¹⁸¹⁵⁰²⁰⁰
^Old^e^r
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregard^y^es^y^e^s
^A^{sset T}^e^stsⁿ^oⁿ^o
^Continuous^Elig^ibility^(m^onths⁾⁰¹²
^P^r^e^s^um^ptiv^e^Elig^ibility^no^y^e^s
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿ^N^A^y^e^s^a
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no^no
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^N^A^y^es
^Slidⁱⁿ^g^{Scale f}^o^{r Co}^st-Sh^a^rin^g^NAⁿ^o
^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d¹²³⁴¹²³⁴
^Ran^g^{e (%}^FP^L⁾¹⁵⁰²⁰⁰
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d^m^onthly
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d^$⁵
^Fa^m^ily^Ca^p^$⁵
^Co^-Pa^y^m^e^nts
^C^o^-^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s^$⁰
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s^$⁰
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}^E^m^erg-Ro^o^m^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}
^Em^e^r^g^-^R^oom^$⁰
^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^T^y^pe^N^A^B^e^nc^hm^a^r^k
^Option^N^A^S^ta^te^Em^ploy^e^e
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^d-Out
⁽^m^onths⁾⁰⁶
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no^no
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r
^Subs^idy^N^A^N^A
^a^.^{MI of}^f^e^rs^preⁿ^a^t^a^l^c^a^r^e^f^r^om^c^onc^e^p^{tion throug}^{h birt}^h^{to pre}^g^na^{nt w}^o^m^e^{n in f}^a^m^ilie^s^w^{ith inc}^o^m^e^{up to 185%}
^FP^L^.

^Pr^o^g^r^a^m^In^fo
^Sta^t^e^Minnesota.^Me^dic^aⁱ^{d Ex}^pa^ns^{ion O}ⁿ^ly
^P^r^og^r^a^m^N^a^m^e^Minne^s^o^ta^Me^dic^a^l^A^s^sⁱ^s^t^aⁿ^c^e^P^r^og^r^a^m
^T^y^pe^O^f^P^r^og^r^a^m^M^e^d^ic^aⁱ^{d Ex}^pa^ns^ion
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^ise^A^f^f^e^c^ting^this
^Pr^o^g^r^a^mⁿ^o
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r^G^r^oups^N^o^t^a
^Elig^ible^f^o^{r this P}^r^og^ra^m^y^e^s
^Eligib^ility
^A^g^e^I^nc^om^e⁽^%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t⁰²²⁷⁵²⁸⁰
^N^e^x^t^Y^oung^e^s^t
^Old^e^r
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregard^y^es
^A^{sset T}^e^stsⁿ^o
^Continuous^Elig^ibility^(m^onths⁾⁰
^P^r^e^s^um^ptiv^e^Elig^ibility^no
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿ^N^A
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^N^A
^Slidⁱⁿ^g^{Scale f}^o^{r Co}^st-Sh^a^rin^g^NA
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d^G^r^{oup 1}^G^r^{oup 2}^G^r^{oup 3}^G^r^{oup 4}
^Ran^g^{e (%}^FP^L⁾
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d
^Fa^m^ily^Ca^p
^Co^-Pa^y^m^e^nts
^C^o^-^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s
^Co^-P^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}^E^m^erg-Ro^o^m
^Co^-P^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}^E^m^erg-Ro^o^m
^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^Ty^p^e^N^A
^Option^N^A
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^{d-Out (m}^onths)⁰
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r^Subs^idy^N^A
^{a. Mi}ⁿⁿ^e^s^o^t^a^’^s^S^ectⁱ^oⁿ¹¹¹⁵^w^aⁱ^v^{er al}^l^o^w^s^t^h^{e s}^t^at^{e t}^o^u^s^{e S}^C^H^I^{P f}^uⁿ^d^s^t^o^cov^e^{r paren}^t^s^an^{d rel}^a^tⁱ^v^e
^caret^ak^ers^of^Medi^cai^{d an}^{d S}^C^H^I^P^elⁱ^gⁱ^b^l^e^chⁱ^l^d^ren^w^h^os^{e i}ⁿ^com^e^l^e^v^e^lⁱ^s^bet^w^een^{100 t}^o
^200%^F^P^L^.

^Pr^o^g^r^a^m^In^fo
^Sta^t^e^Mississippi.^Se^pa^ra^te^Sta^t^e^P^r^og^ra^m^Oⁿ^ly
^P^r^o^g^ram^Nam^e^Mississip^pⁱ^Hea^lth^Ben^e^f^{its P}^r^o^g^ram^(II)
^T^y^p^e^Of^P^r^o^g^ram^S^ep^arat^{e S}^t^at^{e P}^r^o^g^ram
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^ise^A^f^f^e^c^ting^this
^Pr^o^g^r^a^mⁿ^o
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r^G^r^oups^N^o^t
^Elig^ible^f^o^{r this P}^r^og^ra^mⁿ^o
^Eligib^ility
^A^g^e^I^nc^om^e⁽^%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t⁰¹¹⁸⁵²⁰⁰
^N^e^x^t^Y^oung^e^s^t¹⁵¹³³²⁰⁰
^O^l^de^r⁶¹⁸¹⁰⁰²⁰⁰
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregard^y^es
^A^{sset T}^e^stsⁿ^o
^Continuous^Elig^ibility^(m^onths⁾¹²
^P^r^e^s^um^ptiv^e^Elig^ibility^no^a
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿⁿ^o
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^y^es
^Sliding^Sc^a^l^e^f^o^{r Cost-Sha}^ring^inc^o^m^e^b
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d^G^r^{oup 1}^G^r^{oup 2}^G^r^{oup 3}^G^r^{oup 4}
^Ran^g^{e (%}^FP^L⁾¹⁰⁰¹⁵⁰¹⁷⁵¹⁵⁰¹⁷⁵²⁰⁰
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d^no
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d
^Fa^m^ily^Ca^p
^Co^-Pa^y^m^e^nts
^C^o^-^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s^$⁰^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s^$⁰^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s^$⁰^$⁵^$⁵
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s^$⁰^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}^E^m^erg-Ro^o^m^$⁰^$¹⁵^$¹⁵
^C^o^-^P^a^y^m^e^{nt For}^N^on-^Em^e^r^g^U^s^e^O^f^Em^e^r^g^-^R^oom^$⁰^$¹⁵^$¹⁵
^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^T^y^p^e^S^ecret^ary^A^p^p^r^o^v^ed
^O^p^tion^B^eⁿ^c^h^m^a^r^k^P^l^us^A^dditiona^l^c
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^{d-Out (m}^onths)⁰
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no^d
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r^Subs^idy^N^A^d
^a^.^{MS ha}^{s CMS a}^pprov^a^l^{to use}^pre^s^um^ptiv^e^e^lig^ibility^{but ha}^{s c}^hoseⁿ^{not to im}^ple^m^eⁿ^{t it.}
^b.^T^h^e^dif^f^e^r^e^nc^e^{in c}^o^s^t^-^s^ha^rⁱ^ng^be^tw^e^eⁿ^G^r^oups^{2 a}^{nd 3 is}^tha^t^the^out-^o^f^-^poc^k^e^t^m^a^xⁱ^m^u^m^is^$800^f^o^r^G^r^oup
^{2 a}^{nd $950 f}^o^r^G^r^{oup 3.}
^c^.^Sta^t^e^e^m^ploy^e^e^plaⁿ^plus^de^nta^l^a^{nd v}ⁱ^sⁱ^{on be}^ne^f^its^.
^{d. MS ha}^s^C^M^{S a}^ppr^ov^a^l^{to s}^ubs^idiz^e^ES^I^,^b^u^t^the^pr^og^r^a^m^ha^s^{not be}^eⁿ^im^ple^m^eⁿ^te^{d a}^{nd is}^{on hold}
^inde^fⁱ^nite^ly^.

^Pr^o^g^r^a^m^In^fo
^Sta^t^e^Missouri.^Me^dic^aⁱ^{d Ex}^pa^ns^{ion O}ⁿ^ly
^P^r^og^r^a^m^N^a^m^e^Ma^na^g^e^{d C}^a^r^e^P^l^us^f^o^r^Kⁱ^ds
^T^y^pe^O^f^P^r^og^r^a^m^M^e^d^ic^aⁱ^{d Ex}^pa^ns^ion
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^ise^A^f^f^e^c^ting^this^a
^Pr^o^g^r^a^m^y^e^s
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r^G^r^oups^N^o^t
^Elig^ible^f^o^{r this P}^r^og^ra^mⁿ^o
^Eligib^ility
^A^g^e^I^nc^om^e⁽^%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t⁰¹¹⁸⁵³⁰⁰
^N^e^x^t^Y^oung^e^s^t¹⁵¹³³³⁰⁰
^O^l^de^r⁶¹⁸¹⁰⁰³⁰⁰
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregard^y^es
^A^{sset T}^e^stsⁿ^o
^Continuous^Elig^ibility^(m^onths⁾⁰
^P^r^e^s^um^ptiv^e^Elig^ibility^y^e^s
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿ^N^A
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^y^es^a
^Sliding^Sc^a^l^e^f^o^{r Cost-Sha}^ring^inc^o^m^e^b
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d^G^r^{oup 1}^G^r^{oup 2}^G^r^{oup 3}^G^r^{oup 4}
^Ran^g^{e (%}^FP^L⁾¹⁸⁵²²⁵²⁵⁰²⁷⁵²²⁵²⁵⁰²⁷⁵³⁰⁰
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d^m^onthly^c
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d^$⁰^$⁵⁹^$⁶⁹^$⁷⁸
^Fa^m^ily^C^a^p^$⁰^$²⁰⁶^$²²⁵^$²²⁵
^Co^-Pa^y^m^e^nts
^C^o^-^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s^$⁰^$⁹^$⁹^$⁹
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s^$⁰^$⁹^$⁹^$⁹
^Co^-P^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s^$⁵^$¹⁰^$¹⁰^$¹⁰
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s^$⁰^$⁰^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}^E^m^erg-Ro^o^m^$⁰^$⁰^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}^E^m^erg-Ro^o^m^$⁰^$⁰^$⁰^$⁰
^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^T^y^pe^C^o^m^p^r^e^he^ns^iv^e^Me^dic^aⁱ^{d Se}^c^{tion 1115 w}^a^iv^e^r
^Option^N^A
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^{d-Out (m}^onths)⁶^a
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r^Subs^idy^N^A
^a.^M^O^u^s^e^s^SC^H^I^P^f^unds^{to e}^x^pa^{nd its}^c^o^m^p^r^e^he^ns^iv^e^Me^dic^aⁱ^{d Se}^c^{tion 1115 w}^a^iv^e^r^{, w}^h^ic^{h, a}^m^on^g^o^t^h^e^r
^thⁱⁿ^g^s^{, allo}^w^s^{a six}^m^oⁿ^t^h^w^a^itin^g^p^e^rio^d^an^d^co^{st sh}^arin^g^th^{at ex}^ceed^{s M}^e^dⁱ^caid^allo^w^a^b^l^{e am}^ounts^.
^{b. T}^h^e^r^e^is^{no c}^o^s^t^-^s^ha^rⁱ^ng^f^o^r^eⁿ^r^o^lle^e^s^w^{ith f}^a^m^ily^inc^o^m^e^be^tw^e^eⁿ^100-^185%^FP^L^.
^c^.^T^h^e^pe^r^-^c^{hild a}^m^{ount s}^how^{n is}^c^o^s^t^of^the^fⁱ^r^s^{t c}^h^{ild; s}^u^ccessi^{ve ch}ⁱ^l^d^ren^{are ch}^arged^{a l}^o^w^e^{r p}^r^emⁱ^u^m^.

^Pr^o^g^r^a^m^In^fo
^Sta^t^e^Montana.^Se^pa^ra^te^Sta^t^e^P^r^og^ra^m^Oⁿ^ly
^P^r^og^r^a^m^N^a^m^e^Montaⁿ^a^C^H^I^P
^T^y^p^e^Of^P^r^o^g^ram^S^ep^arat^{e S}^t^at^{e P}^r^o^g^ram
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^ise^A^f^f^e^c^ting^this
^Pr^o^g^r^a^mⁿ^o
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r^G^r^oups^N^o^t
^Elig^ible^f^o^{r this P}^r^og^ra^mⁿ^o
^Eligib^ility
^A^g^e^I^nc^om^e⁽^%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t⁰⁵¹³³¹⁵⁰
^N^e^x^t^Y^oung^e^s^t⁶¹⁸¹⁰⁰¹⁵⁰
^Old^e^r
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregard^y^es
^A^{sset T}^e^stsⁿ^o
^Continuous^Elig^ibility^(m^onths⁾¹²
^P^r^e^s^um^ptiv^e^Elig^ibility^no
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿⁿ^o
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^y^e^s
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^y^es
^Slidⁱⁿ^g^{Scale f}^o^{r Co}^st-Sh^a^rin^gⁿ^o
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d^G^r^{oup 1}^G^r^{oup 2}^G^r^{oup 3}^G^r^{oup 4}
^Ran^g^{e (%}^FP^L⁾¹⁰⁰¹⁵⁰
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d^no
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d
^Fa^m^ily^Ca^p
^Co^-Pa^y^m^e^nts
^C^o^-^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s^$⁵
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s^$³
^Co^-P^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s^$³
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s^$²⁵
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}^E^m^erg-Ro^o^m^$⁵
^Co^-P^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}^E^m^erg-Ro^o^m^$⁵
^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^T^y^pe^B^e^nc^hm^a^r^k^Equiv^a^le^nt
^Option^S^ta^te^Em^ploy^e^e
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^{d-Out (m}^onths)³
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r^Subs^idy^N^A

^Pr^o^g^r^a^m^In^fo
^Sta^t^e^N^e^br^aska.^Me^dic^aⁱ^{d Ex}^pa^ns^{ion O}ⁿ^ly
^P^r^og^r^a^m^N^a^m^e^Kⁱ^ds^C^onne^c^tion
^T^y^pe^O^f^P^r^og^r^a^m^M^e^d^ic^aⁱ^{d Ex}^pa^ns^ion
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^ise^A^f^f^e^c^ting^this
^Pr^o^g^r^a^mⁿ^o
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r^G^r^oups^N^o^t
^Elig^ible^f^o^{r this P}^r^og^ra^mⁿ^o
^Eligib^ility
^A^g^e^I^nc^om^e⁽^%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t⁰¹¹⁵⁰¹⁸⁵
^N^e^x^t^Y^oung^e^s^t¹⁵¹³³¹⁸⁵
^O^l^de^r⁶¹⁸¹⁰⁰¹⁸⁵
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregard^y^es
^A^{sset T}^e^stsⁿ^o
^Continuous^Elig^ibility^(m^onths⁾⁶^a
^P^r^e^s^um^ptiv^e^Elig^ibility^y^e^s
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿ^N^A
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^N^A
^Slidⁱⁿ^g^{Scale f}^o^{r Co}^st-Sh^a^rin^g^NA
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d^G^r^{oup 1}^G^r^{oup 2}^G^r^{oup 3}^G^r^{oup 4}
^Ran^g^{e (%}^FP^L⁾
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d
^Fa^m^ily^Ca^p
^Co^-Pa^y^m^e^nts
^C^o^-^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s
^Co^-P^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}^E^m^erg-Ro^o^m
^Co^-P^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}^E^m^erg-Ro^o^m
^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^Ty^p^e^N^A
^Option^N^A
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^{d-Out (m}^onths)⁰
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r^Subs^idy^N^A
^a^.^Iⁿ^N^E^{, only}^the^fⁱ^r^s^{t s}ⁱ^x^m^onths^of^c^o^v^e^r^a^g^e^a^r^e^c^ontinuous^.

^Pr^o^g^r^a^m^In^fo
^Sta^t^e^Ne^v^a^da^.^Se^pa^ra^te^Sta^t^e^P^r^og^ra^m^Oⁿ^ly
^P^r^o^g^ram^Nam^e^Nevad^a^Ch^{eck Up}
^T^y^p^e^Of^P^r^o^g^ram^S^ep^arat^{e S}^t^at^{e P}^r^o^g^ram
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^ise^A^f^f^e^c^ting^this
^Pr^o^g^r^a^mⁿ^o
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r^G^r^oups^N^o^t
^Elig^ible^f^o^{r this P}^r^og^ra^mⁿ^o
^Eligib^ility
^A^g^e^I^nc^om^e⁽^%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t⁰⁵¹³³²⁰⁰
^N^e^x^t^Y^oung^e^s^t⁶¹⁸¹⁰⁰²⁰⁰
^Old^e^r
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregardⁿ^o
^A^{sset T}^e^stsⁿ^o
^Continuous^Elig^ibility^(m^onths⁾¹²
^P^r^e^s^um^ptiv^e^Elig^ibility^no
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿⁿ^o
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^y^es
^Sliding^Sc^a^l^e^f^o^{r Cost-Sha}^ring^inc^o^m^e
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d^G^r^{oup 1}^G^r^{oup 2}^G^r^{oup 3}^G^r^{oup 4}
^Ran^g^{e (%}^FP^L⁾¹⁰⁰¹⁵⁰¹⁷⁵¹⁵⁰¹⁷⁵²⁰⁰
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d^qua^r^t^e^r^ly
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d^$¹⁰^$²⁵^$⁵⁰
^Fa^m^ily^C^a^p^$¹⁰^$²⁵^$⁵⁰
^Co^-Pa^y^m^e^nts
^C^o^-^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s^$⁰^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s^$⁰^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s^$⁰^$⁰^$⁰
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s^$⁰^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}^E^m^erg-Ro^o^m^$⁰^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}^E^m^erg-Ro^o^m^$⁰^$⁰^$⁰
^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^T^y^p^e^S^ecret^ary^A^p^p^r^o^v^ed
^Op^tⁱ^oⁿ^S^am^{e as M}^e^dⁱ^cai^d
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^{d-Out (m}^onths)⁶
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r^Subs^idy^N^A

^Pr^o^g^r^a^m^In^fo
^Sta^t^e^Ne^w^Ha^m^p^s^h^ire^.^Com^b^ina^tion
^P^r^og^ra^m^Na^m^e^He^a^lthy^{Kids - G}^o^ld^He^a^lthy^{Kids - Silv}^e^r
^T^y^p^e^Of^P^r^o^g^ram^M^edⁱ^cai^d^E^x^p^aⁿ^sⁱ^oⁿ^S^ep^arat^{e S}^t^at^{e P}^r^o^g^ram
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^ise^A^f^f^e^c^ting^this
^Pr^o^g^r^a^mⁿ^oⁿ^o
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r
^G^r^oups^N^o^{t Elig}^ible^f^o^r^this^P^r^og^r^a^mⁿ^oⁿ^o
^Eligib^ility
^In^co^m^e^In^co^m^e
^Ag^e^(%^FP^L⁾^A^g^e^(%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t⁰¹¹⁸⁵³⁰⁰¹¹⁸¹⁸⁵³⁰⁰
^N^e^x^t^Y^oung^e^s^t
^Old^e^r
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregard^y^es^y^e^s
^A^{sset T}^e^stsⁿ^oⁿ^o
^Continuous^Elig^ibility^(m^onths⁾⁰⁰
^P^r^e^s^um^ptiv^e^Elig^ibility^y^e^sⁿ^o
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿ^N^Aⁿ^o
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no^no
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^N^A^y^es
^Sliding^Sc^a^l^e^f^o^{r Cost-Sha}^ring^NA^inc^o^m^e
^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d¹²³⁴¹²³⁴
^Ran^g^{e (%}^FP^L⁾¹⁸⁵²⁵⁰²⁵⁰³⁰⁰
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d^m^onthly
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d^$²⁵^$⁴⁵
^Fa^m^ily^C^a^p^$¹⁰⁰^$¹³⁵
^Co^-Pa^y^m^e^nts
^C^o^-^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s^$¹⁰^$¹⁰
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s^$⁵^$⁵
^Co^-P^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s^$¹⁰^$¹⁰
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}^E^m^erg-Ro^o^m^$⁵⁰^$⁵⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}
^Em^e^r^g^-^R^oom^$⁵⁰^$⁵⁰
^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^T^y^pe^N^A^B^e^nc^hm^a^r^k^Equiv^a^le^nt
^Option^N^A^F^EHBP
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^d-Out
⁽^m^onths⁾⁰⁶
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no^no
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r
^Subs^idy^N^A^N^A

CRS-60
^g^r^a^m^In^fo
^e^N^e^w^Jer^sey^.^Com^b^ina^tion
^ra^m^Na^m^e^{NJ Fa}^m^ily^Ca^re^P^l^aⁿ^A^N^{J Fa}^m^ily^Ca^re^P^l^aⁿ^B^N^{J Fa}^m^ily^Ca^re^P^l^aⁿ^C^N^{J Fa}^m^ily^Ca^re^P^l^aⁿ^D
^e^Of^P^r^o^g^ram^M^edⁱ^cai^d^E^x^p^aⁿ^sⁱ^oⁿ^S^ep^arat^{e S}^t^at^{e P}^r^o^g^ram^S^ep^arat^{e S}^t^at^{e P}^r^o^g^ram^S^ep^arat^{e S}^t^at^{e P}^r^o^g^ram
^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^iv^ing^P^r^ov^{isions Othe}^rw^ise^A^f^f^e^c^ting^this
^m^on^onⁿ
ⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r^G^r^oups^N^o^t^a^a^a^a
^ible^f^o^{r this P}^r^og^ra^m^y^e^s^ye^s^ye^s^ye^s
^ility
^A^g^e^I^nc^om^e⁽^%^FP^L⁾^A^g^e^I^nc^om^e⁽^%^FP^L⁾^A^g^e^I^nc^om^e⁽^%^FP^L⁾^A^g^e^I^nc^om^e⁽^%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^e^s^t⁶¹⁸¹⁰⁰¹³³¹¹⁸¹³³¹⁵⁰⁰¹¹⁸⁵²⁰⁰⁰¹⁸²⁰⁰³⁵⁰
^t^Y^oung^e^s^t¹¹⁸¹⁵⁰²⁰⁰
ⁱ^{ki/CRS-RL32389}^e^r
^g/w^e^st
^s^.or^{c In}^co^m^e^Di^sregard^y^esⁿ^oⁿ^o^y^e^s^b
^le^ak^e^stsⁿ^oⁿ^oⁿ^oⁿ^o
^://wiki^Elig^ibility^(m^onths⁾⁰⁰⁰⁰^s^um^ptiv^e^Elig^ibility^y^e^s^y^e^s^y^e^sⁿ^o
^h^ttpⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿ^N^Aⁿ^oⁿ^oⁿ^o
^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no^no^no^no
^h^arin^g
^arin^g^Req^uⁱ^red^N^Aⁿ^o^y^es^y^e^s
^Sc^a^l^e^f^o^{r Cost-Sha}^ring^NA^NA^no^inc^o^m^e
^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup
^ale^G^r^{oup D}^e^fⁱ^ne^d¹²³⁴¹²³⁴¹²³⁴¹²³⁴
^g^{e (%}^FP^L⁾¹⁵⁰²⁰⁰²⁵⁰³⁰⁰²⁰⁰²⁵⁰³⁰⁰³⁵⁰
^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d^m^onthly^m^onthly
ⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d^$¹⁵^$³⁰^$⁶⁰^$¹⁰⁰
^ily^Ca^p^$¹⁵^$³⁰^$⁶⁰^$¹⁰⁰

CRS-61
^y^m^e^nts
^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s^$5^$5^$⁵^$5
^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s^$1^$5^$⁵^$5
^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s^$5^$5^$⁵^$5
^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s^$0^$0^$⁰^$0
^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}^E^m^erg-Ro^o^m^$¹⁰^$³⁵^$³⁵^$³⁵
^P^a^y^m^e^{nt For}^N^on-^Em^e^r^g^U^s^e^O^f^Em^e^r^g^-^R^oom^$¹⁰^$³⁵^$³⁵^$³⁵
^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^N^A^B^e^nc^hm^a^r^k^B^eⁿ^c^h^m^a^r^k^B^e^nc^hm^a^r^k
ⁿ^N^A^F^EHBP^F^E^HBP^L^{argest HM}^O
^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^{d-Out (m}^onths)⁰⁶⁶⁶
^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no^y^e^s^c^ye^s^c^ye^s^c
^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r^Subs^idy^N^A^50%^50%^50%
ⁱ^{ki/CRS-RL32389}
^g/w^e^w^J^e^r^s^e^y^’^s^Se^c^{tion 1115 w}^a^iv^e^r^a^llow^s^the^s^t^a^t^e^{to c}^o^v^e^r⁽¹⁾^pa^r^e^nts^of^c^h^ildr^e^{n e}^lig^ible^f^o^r^the^N^J^Kⁱ^dC^a^r^e^pr^og^r^a^m^,^inc^l^uding^pa^r^e^nts^w^{ith inc}^o^m^e^be^low^133%^of^the^FP^L^{in the}^Me^dic^aⁱ^{d Ex}^pa^ns^ion
^s^.or^pr^og^r^a^m^a^{nd pa}^r^e^nts^be^tw^e^eⁿ^{134 a}^{nd 200%}^FP^L^{in the}^s^e^pa^r^a^te^c^h^{ild he}^a^{lth pr}^og^r^a^m^,^a^{nd (}²⁾^pr^e^g^na^{nt w}^o^m^e^{n be}^tw^e^eⁿ^{185 a}^{nd 200%}^FP^L^w^{ho a}^r^e^{not e}^lig^ible^f^o^r^Me^dic^aⁱ^d.
^le^ak^h^e^s^t^a^t^e^dis^r^e^g^a^r^ds^a^{ll inc}^o^m^e^be^tw^e^eⁿ^200%^-350%^FP^L^{to de}^te^rm^ine^e^lig^ibility^f^o^{r Fa}^m^ily^Ca^re^P^l^aⁿ^D^.
ⁱ^l^d^ren^w^h^o^s^{e p}^a^ren^t^{s h}^a^{ve access t}^o^em^p^l^o^y^er-s^pons^or^e^d^ins^u^r^a^nc^e^tha^t^is^c^o^s^t^-^e^f^f^e^c^tiv^e^a^{nd tha}^t^m^e^e^t^s^the^be^ne^f^its^qua^lif^ic^a^tions^m^u^s^t^eⁿ^r^o^{ll in the}^e^m^ploy^e^r^plaⁿ^f^o^r^f^a^mⁱ^l^y^co^ver^a^ge.

^://wiki
^h^ttp

^Pr^o^g^r^a^m^In^fo
^Sta^t^e^N^e^w^Mexico.^Me^dic^aⁱ^{d Ex}^pa^ns^{ion O}ⁿ^ly
^P^r^og^r^a^m^N^a^m^e^Sa^lud!^Me^dic^aⁱ^d
^T^y^pe^O^f^P^r^og^r^a^m^M^e^d^ic^aⁱ^{d Ex}^pa^ns^ion
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^ise^A^f^f^e^c^ting^this^a
^Pr^o^g^r^a^m^y^e^s
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r^G^r^oups^N^o^t^b
^Elig^ible^f^o^{r this P}^r^og^ra^m^y^e^s
^Eligib^ility
^A^g^e^I^nc^om^e⁽^%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t⁰¹⁸¹⁸⁵²³⁵
^N^e^x^t^Y^oung^e^s^t
^Old^e^r
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregard^y^es
^A^{sset T}^e^stsⁿ^o
^Continuous^Elig^ibility^(m^onths⁾¹²
^P^r^e^s^um^ptiv^e^Elig^ibility^y^e^s
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿ^N^A
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^y^es^a
^Slidⁱⁿ^g^{Scale f}^o^{r Co}^st-Sh^a^rin^gⁿ^o
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d^G^r^{oup 1}^G^r^{oup 2}^G^r^{oup 3}^G^r^{oup 4}
^Ran^g^{e (%}^FP^L⁾¹⁸⁵²³⁵
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d^no
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d
^Fa^m^ily^Ca^p
^Co^-Pa^y^m^e^nts
^C^o^-^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s^$²
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s^$²
^Co^-P^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s^$⁵
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s^$²⁵
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}^E^m^erg-Ro^o^m^$¹⁵
^Co^-P^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}^E^m^erg-Ro^o^m^$¹⁵
^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^T^y^pe^C^o^m^p^r^e^he^ns^iv^e^Me^dic^aⁱ^{d Se}^c^{tion 1115 w}^a^iv^e^r
^Option^N^A
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^{d-Out (m}^onths)⁰
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r^Subs^idy^N^A
^a.^NM^u^s^e^s^SC^H^I^P^f^unds^{to e}^x^pa^{nd its}^c^o^m^p^r^e^he^ns^iv^e^Me^dic^aⁱ^{d Se}^c^{tion 1115 w}^a^iv^e^r^{, w}^h^ic^{h, a}^m^on^g^o^t^h^e^r
^t^hⁱⁿ^gs,^al^l^o^w^s^co^st^sh^ariⁿ^{g t}^h^at^exceed^{s M}^e^dⁱ^cai^d^al^l^o^w^a^b^l^{e am}^ounts^.
^b^.^New^M^e^xi^co^{’s HIF}^A^w^aⁱ^v^{er al}^l^o^w^s^t^h^{e st}^at^{e t}^o^co^ve^r^unins^ur^e^d^pa^r^e^nts^a^{nd c}^h^ildle^s^s^a^dults^w^{ith inc}^o^m^e^s^up
^{to 200%}^FP^L^.

^Pr^o^g^r^a^m^In^fo
^Sta^t^e^Ne^w^York^.^Com^b^ina^tion
^{Child He}^a^{lth P}^l^{us A}^:^G^r^ow^ing^Up^{Child He}^a^{lth P}^l^{us B: G}^r^ow^ing^Up
^P^r^o^g^r^a^{m N}^a^me^He^a^lthy^He^a^lthy
^T^y^p^e^Of^P^r^o^g^ram^M^edⁱ^cai^d^E^x^p^aⁿ^sⁱ^oⁿ^S^ep^arat^{e S}^t^at^{e P}^r^o^g^ram
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^isions
^Othe^rw^ise^A^f^f^e^c^ting^this^a^a
^Pr^o^g^r^a^mⁿ^o^no
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P
^Funds^{to C}^o^v^e^r^G^r^oups^N^o^t^a^a
^Elig^ible^f^o^{r this P}^r^og^ra^mⁿ^o^no
^Eligib^ility
^A^g^e^I^nc^om^e⁽^%^FP^L⁾^A^g^e^I^nc^om^e⁽^%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t⁶¹⁸¹⁰⁰¹³³⁰¹¹⁸⁵²⁵⁰
^N^e^x^t^Y^oung^e^s^t¹¹⁸¹³³²⁵⁰
^Old^e^r
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregard^y^esⁿ^o
^A^{sset T}^e^stsⁿ^oⁿ^o
^Continuous^Elig^ibility
⁽^m^onths⁾¹²⁰
^P^r^e^s^um^ptiv^e^Elig^ibility^no^y^e^s
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nborⁿ
^Childreⁿ^N^Aⁿ^o
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting
^Lⁱ^s^t^no^no
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^N^A^y^es
^Sliding^Sc^a^l^e^f^o^r
^Co^st-Sh^a^rin^g^NAⁱⁿ^co^m^e
^{Sliding Sc}^ale^G^r^oup
^Defin^e^d^G^r^{oup 1}^G^r^{oup 2}^G^r^{oup 3}^G^r^{oup 4}^G^r^{oup 1}^G^r^{oup 2}^G^r^{oup 3}^G^r^{oup 4}
^Ran^g^{e (%}^FP^L⁾¹³³¹⁶⁰²²³¹⁶⁰²²³²⁵⁰
^Pre^m^ium^{or Enrollm}^eⁿ^t^m^onthly
^{Fee Req}^uⁱ^r^ed
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d^$⁰^$⁹^$¹⁵
^Fa^m^ily^Ca^p^$⁰^$²⁷^$⁴⁵
^Co^-Pa^y^m^e^nts
^Co^-P^ay^m^eⁿ^t^Fo^{r Bran}^d
^Nam^e^{Rx Dru}^g^s^$⁰^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}
^D^r^u^g^s^$^0$^0$⁰
^Co^-P^ay^m^eⁿ^t^Fo^{r Of}^fⁱ^ce
^Vⁱ^s^t^$0^$0^$0
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^nt
^S^e^r^vⁱ^c^e^s^$0^$0^$0
^Co^-P^ay^m^eⁿ^t^Fo^{r Em}^erg^Use
^O^f^E^e^r^g^-^R^o^m^$0^$0^$0
^Co^-P^ay^m^eⁿ^t^Fo^r
^Noⁿ^-^Em^{erg Use Of}
^E^m^e^r^g^-^R^o^m^$0^$0^$0

^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^T^y^pe^NA^Ex^isting^Com^p^re^he^nsiv^e^Sta^t^e^-^Ba^se^d
^Option^N^A^N^A
^Re^la^tioⁿ^sh^ip^To
^P^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^t
^C^r^ow^d-^O^u^{t (}^m^onths⁾⁰⁰
^Subs^idy^For
^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no^no
^{Min. Em}^ploy^e^r^P^r^e^m^ium
^Sha^r^e^R^e^quir^e^{d f}^o^r^Subs^idy^N^A^N^A
^a^.^N^e^w^Y^o^r^k^C^ity^ha^{d a}^Me^dic^aⁱ^{d a}^{nd SC}^H^I^P^Dⁱ^sast^er^R^e^lⁱ^e^f^w^a^iv^e^r^{to a}^ddr^e^s^s^the^e^f^f^e^c^t^s^of^Se^{pt. 11, 2001.}
^T^h^e^w^a^iv^e^r^w^a^s^e^f^f^e^c^tiv^e^Se^{pt. 11, 2001 thr}^oug^{h J}^a^{n. 31, 2003.}

^Pr^o^g^r^a^m^In^fo
^Sta^t^e^{North Ca}^rolina^.^Se^pa^ra^te^Sta^t^e^P^r^og^ra^m^Oⁿ^ly
^P^r^og^ra^m^Na^m^e^{NC He}^a^{lth Choic}^e^f^o^{r Childre}ⁿ
^T^y^p^e^Of^P^r^o^g^ram^S^ep^arat^{e S}^t^at^{e P}^r^o^g^ram
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^ise^A^f^f^e^c^ting^this
^Pr^o^g^r^a^mⁿ^o
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r^G^r^oups^N^o^t
^Elig^ible^f^o^{r this P}^r^og^ra^mⁿ^o
^Eligib^ility
^A^g^e^I^nc^om^e⁽^%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t⁰¹¹⁸⁵²⁰⁰
^N^e^x^t^Y^oung^e^s^t¹⁵¹³³²⁰⁰
^O^l^de^r⁶¹⁸¹⁰⁰²⁰⁰
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregard^y^es
^A^{sset T}^e^stsⁿ^o
^Continuous^Elig^ibility^(m^onths⁾¹²
^P^r^e^s^um^ptiv^e^Elig^ibility^no
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿⁿ^o
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^y^es
^Sliding^Sc^a^l^e^f^o^{r Cost-Sha}^ring^inc^o^m^e
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d^G^r^{oup 1}^G^r^{oup 2}^G^r^{oup 3}^G^r^{oup 4}
^Ran^g^{e (%}^FP^L⁾¹⁰⁰¹⁵⁰¹⁵⁰²⁰⁰
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d^a^nnua^lly
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d^$⁰^$⁵⁰
^Fa^m^ily^Ca^p^$⁰^$¹⁰⁰
^Co^-Pa^y^m^e^nts
^C^o^-^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s^$⁰^$⁶
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s^$⁰^$⁶
^Co^-P^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s^$⁰^$⁵
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}^E^m^erg-Ro^o^m^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}^E^m^erg-Ro^o^m^$⁰^$²⁰
^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^T^y^pe^B^e^nc^hm^a^r^k
^Option^S^ta^te^Em^ploy^e^e
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^{d-Out (m}^onths)⁰
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r^Subs^idy^N^A

^Pr^o^g^r^a^m^In^fo
^Sta^t^e^{North Da}^k^o^ta^.^Com^b^ina^tion
^P^r^o^g^ram^Nam^e^No^rt^h^Dako^t^a^M^e^dⁱ^cai^d^H^eal^t^h^y^S^t^ep^s
^T^y^p^e^Of^P^r^o^g^ram^M^edⁱ^cai^d^E^x^p^aⁿ^sⁱ^oⁿ^S^ep^arat^{e S}^t^at^{e P}^r^o^g^ram
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^ise^A^f^f^e^c^ting^this
^Pr^o^g^r^a^mⁿ^oⁿ^o
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r^G^r^oups
^{Not Elig}^ible^f^o^{r this P}^r^og^ra^mⁿ^oⁿ^o
^Eligib^ility
^In^co^m^e^a^In^co^m^e
^Ag^e^(%^FP^L⁾^Ag^e^(%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t⁰⁵¹¹³³⁰⁵¹³³¹⁴⁰
^N^e^x^t^Y^oung^e^s^t⁶¹⁸¹¹⁰⁰⁶¹⁸¹⁰⁰¹⁴⁰
^Old^e^r
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregard^y^es^y^e^s
^A^{sset T}^e^stsⁿ^o^a^no
^Continuous^Elig^ibility^(m^onths⁾⁰¹²
^P^r^e^s^um^ptiv^e^Elig^ibility^no^no
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿ^N^Aⁿ^o
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no^no
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^N^A^y^es
^Slidⁱⁿ^g^{Scale f}^o^{r Co}^st-Sh^a^rin^g^NAⁿ^o
^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d¹²³⁴¹²³⁴
^Ran^g^{e (%}^FP^L⁾¹⁰⁰¹⁴⁰
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d^no
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d
^Fa^m^ily^Ca^p
^Co^-Pa^y^m^e^nts
^C^o^-^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s^$²
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s^$²
^Co^-P^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s^$⁰
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s^{$ 0}^b
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}^E^m^erg-Ro^o^m^$⁵
^Co^-P^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}
^Em^e^r^g^-^R^oom^$⁵
^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^T^y^pe^N^A^B^e^nc^hm^a^r^k^Equiv^a^le^nt
^Option^N^A^S^ta^te^Em^ploy^e^e
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^{d-Out (m}^onths)⁰⁶
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no^no
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r
^Subs^idy^N^A^N^A
^a^.^T^h^e^inc^o^m^e^thr^e^s^holds^s^how^{n a}^r^e^us^e^d^f^o^r^{both Me}^dic^aⁱ^{d a}^{nd SC}^H^I^P^pur^pos^e^s^{. N}^D^e^lim^ina^t^e^d^a^s^s^e^{t te}^st^s
^f^r^om^its^Me^dic^aⁱ^{d prog}^ra^m^{in J}^a^{n. 2002. T}^itle^X^I^X^fⁱ^na^nc^ing^is^us^e^d^f^o^r^c^h^ildreⁿ^w^ho^m^e^e^t^the^inc^o^m^e
^th^resh^o^l^d^s^sh^o^wⁿ^an^d^w^h^o^h^a^v^e^a^s^s^e^{ts b}^e^lo^w^th^{e T}^{itle X}^I^X^{asset test th}^resh^o^l^d^sⁱⁿ^p^l^{ace in}^{1997 (}^t^he

^m^a^inte^na^nc^e^of^e^f^f^o^{rt point f}^o^{r SCHIP}⁾^.^T^itle^X^X^I^fⁱ^na^nc^ing^{is use}^d^f^o^{r c}^h^ildre^{n w}^{ho m}^e^e^t^the^inc^o^m^e
^thr^e^s^holds^s^how^{n a}^{nd w}^{ho ha}^v^e^a^s^s^e^ts^ex^ceedⁱⁿ^g^th^{e T}^{itle X}^I^X^{asset test}^th^resh^o^l^d^sⁱⁿ^p^l^{ace in}^1997.
^b.^N^D^r^e^quir^e^s^a^{$50 de}^duc^tible^f^o^r^the^fⁱ^r^s^{t da}^y^of^eachⁱⁿ^p^a^tⁱ^eⁿ^t^h^o^s^pⁱ^t^a^l^ad^mⁱ^ssi^oⁿⁱⁿ^{a gen}^e^ral^h^o^s^pⁱ^t^a^l^o^r^a
^psy^c^hia^t^ric^{or substa}^nc^e^a^buse^inpa^tie^{nt f}^a^c^ility^.

^Pr^o^g^r^a^m^In^fo
^Sta^t^e^Ohⁱ^o^.^Me^dic^aⁱ^{d Ex}^pa^ns^{ion O}ⁿ^ly
^P^r^o^g^r^a^{m N}^a^me^H^e^a^l^t^h^{y S}^t^a^r^t
^T^y^pe^O^f^P^r^og^r^a^m^M^e^d^ic^aⁱ^{d Ex}^pa^ns^ion
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^ise^A^f^f^e^c^ting^this^a
^Pr^o^g^r^a^m^y^e^s
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r^G^r^oups^N^o^t
^Elig^ible^f^o^{r this P}^r^og^ra^mⁿ^o
^Eligib^ility
^A^g^e^I^nc^om^e⁽^%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t⁰⁵¹³³²⁰⁰
^N^e^x^t^Y^oung^e^s^t⁶¹⁸¹⁰⁰²⁰⁰
^Old^e^r
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregard^y^es
^A^{sset T}^e^stsⁿ^o
^Continuous^Elig^ibility^(m^onths⁾⁰
^P^r^e^s^um^ptiv^e^Elig^ibility^no
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿ^N^A
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^N^A
^Slidⁱⁿ^g^{Scale f}^o^{r Co}^st-Sh^a^rin^g^NA
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d^G^r^{oup 1}^G^r^{oup 2}^G^r^{oup 3}^G^r^{oup 4}
^Ran^g^{e (%}^FP^L⁾
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d
^Fa^m^ily^Ca^p
^Co^-Pa^y^m^e^nts
^C^o^-^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s
^Co^-P^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}^E^m^erg-Ro^o^m
^Co^-P^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}^E^m^erg-Ro^o^m
^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^Ty^p^e^N^A
^Option^N^A
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^{d-Out (m}^onths)⁰
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r^Subs^idy^N^A
^a.^{OH h}^a^{s recei}^ved^ap^p^r^o^v^al^f^o^{r a S}^ectⁱ^oⁿ^{1115 w}^a^iv^e^r^a^llowⁱ^ng^aⁿ^a^nnua^l^eⁿ^r^o^l^l^m^eⁿ^t^f^e^e^aⁿ^d¹²^m^oⁿ^t^h^s
^c^ontinuous^c^o^v^e^ra^g^e^f^o^{r c}^h^ildre^{n in}^f^a^m^ilie^s^w^{ith inc}^o^m^e^be^tw^e^eⁿ^151-200%^FP^L^;^how^e^v^e^r^{, the}^s^t^a^t^e^ha^s
^ch^o^s^enⁿ^o^t^t^oⁱ^m^p^l^em^en^t^t^h^{e w}^aⁱ^v^er.

^Pr^o^g^r^a^m^In^fo
^Sta^t^e^O^k^lahoma.^Me^dic^aⁱ^{d Ex}^pa^ns^{ion O}ⁿ^ly
^P^r^og^r^a^m^N^a^m^e^Soone^r^C^a^r^e
^T^y^pe^O^f^P^r^og^r^a^m^M^e^d^ic^aⁱ^{d Ex}^pa^ns^ion
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^ise^A^f^f^e^c^ting^this
^Pr^o^g^r^a^mⁿ^o
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r^G^r^oups^N^o^t
^Elig^ible^f^o^{r this P}^r^og^ra^mⁿ^o
^Eligib^ility
^A^g^e^I^nc^om^e⁽^%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t⁰¹¹⁵⁰¹⁸⁵
^N^e^x^t^Y^oung^e^s^t¹⁵¹³³¹⁸⁵
^O^l^de^r⁶¹⁷¹⁰⁰¹⁸⁵
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregard^y^es
^A^{sset T}^e^stsⁿ^o
^Continuous^Elig^ibility^(m^onths⁾⁰
^P^r^e^s^um^ptiv^e^Elig^ibility^no
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿ^N^A
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^N^A
^Slidⁱⁿ^g^{Scale f}^o^{r Co}^st-Sh^a^rin^g^NA
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d^G^r^{oup 1}^G^r^{oup 2}^G^r^{oup 3}^G^r^{oup 4}
^Ran^g^{e (%}^FP^L⁾
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d
^Fa^m^ily^Ca^p
^Co^-Pa^y^m^e^nts
^C^o^-^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s
^Co^-P^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}^E^m^erg-Ro^o^m
^Co^-P^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}^E^m^erg-Ro^o^m
^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^Ty^p^e^N^A
^Option^N^A
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^{d-Out (m}^onths)⁰
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r^Subs^idy^N^A

^Pr^o^g^r^a^m^In^fo
^Sta^t^e^O^r^egon.^Se^pa^ra^te^Sta^t^e^P^r^og^ra^m^Oⁿ^ly
^P^r^og^r^a^m^N^a^m^e^O^r^e^g^{on C}^h^ildr^e^n’^s^H^e^a^{lth I}ⁿ^s^u^r^a^nc^e^P^r^og^r^a^m
^T^y^p^e^Of^P^r^o^g^ram^S^ep^arat^{e S}^t^at^{e P}^r^o^g^ram
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^ise^A^f^f^e^c^ting^this^a
^Pr^o^g^r^a^m^y^e^s
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r^G^r^oups^N^o^t^a
^Elig^ible^f^o^{r this P}^r^og^ra^m^y^e^s
^Eligib^ility
^A^g^e^I^nc^om^e⁽^%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t¹⁵¹³³¹⁸⁵
^N^e^x^t^Y^oung^e^s^t⁶¹⁸¹⁰⁰¹⁸⁵
^Old^e^r
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregardⁿ^o
^A^{sset T}^e^sts^y^es
^Continuous^Elig^ibility^(m^onths⁾⁶
^P^r^e^s^um^ptiv^e^Elig^ibility^no
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿⁿ^o
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^redⁿ^o
^Slidⁱⁿ^g^{Scale f}^o^{r Co}^st-Sh^a^rin^g^NA
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d^G^r^{oup 1}^G^r^{oup 2}^G^r^{oup 3}^G^r^{oup 4}
^Ran^g^{e (%}^FP^L⁾
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d
^Fa^m^ily^Ca^p
^Co^-Pa^y^m^e^nts
^C^o^-^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s
^Co^-P^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}^E^m^erg-Ro^o^m
^Co^-P^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}^E^m^erg-Ro^o^m
^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^T^y^p^e^S^ecret^ary^A^p^p^r^o^v^ed
^O^p^tion^C^om^pr^e^h^eⁿ^sⁱ^v^e^Me^dic^aⁱ^{d Se}^c^{tion 1115 W}^a^iv^e^r
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^{d-Out (m}^onths)⁶
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^y^e^s^a
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r^Subs^idy^50%
^a^.^O^r^e^g^on’^s^H^I^FA^w^a^iv^e^r^a^llow^s^the^s^t^a^t^e^{to us}^e^Me^dic^aⁱ^{d a}^{nd SC}^H^I^P^f^unds^to^c^o^v^e^r^pr^e^g^na^nt^w^o^m^e^n,^c^h^ildr^e^n,
^pa^r^e^nts^of^Me^dic^aⁱ^{d a}^{nd SC}^H^I^P^c^h^ildr^e^{n, a}^{nd c}^hⁱ^l^d^l^e^s^s^a^dults^{. T}^h^e^w^a^iv^e^r^a^l^s^o^e^x^pa^nds^the^s^t^a^t^e^’^s
^p^r^emⁱ^u^m^assi^st^an^{ce p}^r^o^g^ram^t^o^p^r^o^vⁱ^d^{e a su}^b^sⁱ^d^y^f^o^{r E}^S^{I t}^h^at^can⁽¹^{) o}^f^f^e^{r a red}^u^ced^b^eⁿ^e^fⁱ^t^s^p^ackage
^(h^o^w^ever,^t^h^{e st}^at^{e m}^u^st^en^su^{re t}^h^at^al^l^age-^ap^p^r^o^p^rⁱ^a^t^eⁱ^m^m^uⁿⁱ^zatⁱ^oⁿ^s^{are co}^vered⁾^,^an^d²⁾ⁱ^m^p^o^s^e
^co^st^-sh^a^riⁿ^g^t^h^at^exceed^{s t}^h^{e aggregat}^e,^a^nnua^{l 5%}^of^f^a^m^ily^inc^o^m^e^lim^ita^{tion in the}^SC^H^I^P^s^t^a^t^ute^.^T^h^e
^te^r^m^s^a^nd^c^onditions^of^the^w^a^iv^e^r^pr^os^c^r^ibe^tha^t^eⁿ^rollm^eⁿ^tⁱⁿ^ESI^{is v}^o^lunta^r^y^a^{nd tha}^t^the^sta^t^e^m^u^st
^inf^o^r^m^eⁿ^r^o^lle^e^s^of^the^im^plic^a^tions^of^c^hoos^ing^pr^iv^a^t^e^or^e^m^ploy^e^r^-^s^pons^or^e^d^ins^u^r^a^nc^e^.

^Pr^o^g^r^a^m^In^fo
^Sta^t^e^Pennsy^l^v^a^nia.^Se^pa^ra^te^Sta^t^e^P^r^og^ra^m^Oⁿ^ly
^P^r^og^r^a^m^N^a^m^e^P^e^nns^y^l^v^a^nia^C^H^I^P
^T^y^p^e^Of^P^r^o^g^ram^S^ep^arat^{e S}^t^at^{e P}^r^o^g^ram
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^ise^A^f^f^e^c^ting^this
^Pr^o^g^r^a^mⁿ^o
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r^G^r^oups^N^o^t
^Elig^ible^f^o^{r this P}^r^og^ra^mⁿ^o
^Eligib^ility
^A^g^e^I^nc^om^e⁽^%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t⁰¹¹⁸⁵²⁰⁰
^N^e^x^t^Y^oung^e^s^t¹⁵¹³³²⁰⁰
^O^l^de^r⁶¹⁸¹⁰⁰²⁰⁰
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregard^y^es
^A^{sset T}^e^stsⁿ^o
^Continuous^Elig^ibility^(m^onths⁾¹²
^P^r^e^s^um^ptiv^e^Elig^ibility^no
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿⁿ^o
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^redⁿ^o
^Slidⁱⁿ^g^{Scale f}^o^{r Co}^st-Sh^a^rin^g^NA
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d^G^r^{oup 1}^G^r^{oup 2}^G^r^{oup 3}^G^r^{oup 4}
^Ran^g^{e (%}^FP^L⁾
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d
^Fa^m^ily^Ca^p
^Co^-Pa^y^m^e^nts
^C^o^-^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s
^Co^-P^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}^E^m^erg-Ro^o^m
^Co^-P^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}^E^m^erg-Ro^o^m
^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^T^y^pe^Ex^isting^Com^p^re^he^nsiv^e^Sta^t^e^-^Ba^se^d
^Option^N^A
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^{d-Out (m}^onths)⁰
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r^Subs^idy^N^A

^Pr^o^g^r^a^m^In^fo
^Sta^t^e^{Rhode Island.}^Com^b^ina^tion
^P^r^o^g^ram^Nam^e^{RIte Care}^{RIte Care}
^T^y^p^e^Of^P^r^o^g^ram^M^edⁱ^cai^d^E^x^p^aⁿ^sⁱ^oⁿ^S^ep^arat^{e S}^t^at^{e P}^r^o^g^ram
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^ise^A^f^f^e^c^ting^a
^{this P}^r^og^ra^m^y^e^s^no
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r^b^b
^G^r^oups^N^o^{t Elig}^ible^f^o^r^this^P^r^og^r^a^m^y^e^s^ye^s
^Eligib^ility
^In^co^m^e^In^co^m^e
^Ag^e^(%^FP^L⁾^A^g^e^(%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t⁸¹⁸¹⁰⁰²⁵⁰^cc^c^c
^N^e^x^t^Y^oung^e^s^t
^Old^e^r
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregard^y^es^y^e^s
^A^{sset T}^e^stsⁿ^oⁿ^o
^Continuous^Elig^ibility^(m^onths⁾⁰¹²
^P^r^e^s^um^ptiv^e^Elig^ibility^no^no
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿ^N^A^y^e^s^c
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no^no
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^y^es^y^e^s
^Sliding^Sc^a^l^e^f^o^{r Cost-Sha}^ring^inc^o^m^e^inc^o^m^e
^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d¹²³⁴¹²³⁴
^Ran^g^{e (%}^FP^L⁾¹⁰⁰¹⁵⁰¹⁸⁵²⁰⁰¹⁰⁰¹⁵⁰¹⁸⁵²⁰⁰¹⁵⁰¹⁸⁵²⁰⁰²⁵⁰¹⁵⁰¹⁸⁵²⁰⁰²⁵⁰
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d^m^onthly^m^onthly
^P^r^e^mⁱ^u^m^/^F^e^e^P^e^r^C^hⁱ^l^d^$⁰^$⁶^1$⁷⁷^$⁹²^$^0$⁶¹^$⁷^7$⁹²
^F^a^mⁱ^l^y^C^a^p^$^0$⁶¹^$⁷^7$⁹²^$⁰^$⁶^1$⁷⁷^$⁹²
^Co^-Pa^y^m^e^nts
^C^o^-^P^a^y^m^eⁿ^t^F^o^r^B^r^aⁿ^d^N^a^m^e^R^x^D^r^u^g^s^$^0$^0$^0$⁰^$^0$^0$^0$⁰
^C^o^-^P^a^y^m^eⁿ^t^F^o^r^G^eⁿ^e^rⁱ^c^R^x^D^r^u^g^s^$^0$^0$^0$⁰^$^0$^0$^0$⁰
^C^o^-^P^a^y^m^eⁿ^t^F^o^r^O^fⁱ^c^e^Vⁱ^sⁱ^t^s^$0^$⁰^$⁰^$⁰^$0^$⁰^$0^$⁰
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s^$⁰^$⁰^$⁰^$⁰^$⁰^$⁰^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}
^E^m^e^r^g^-^R^o^m^$0^$⁰^$⁰^$⁰^$0^$⁰^$0^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}
^E^m^e^r^g^-^R^o^m^$0^$⁰^$⁰^$⁰^$0^$⁰^$0^$⁰
^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^C^o^m^p^r^e^he^ns^iv^e^Me^dic^aⁱ^d
^Ty^p^e^Se^c^{tion 1115 W}^a^iv^e^r^Se^c^r^e^t^a^r^y^A^ppr^ov^e^d
^C^o^m^p^r^e^he^ns^iv^e^Me^dic^aⁱ^d
^Option^N^A^Se^c^{tion 1115 W}^a^iv^e^r
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^d-Out
⁽^m^onths⁾⁰⁰
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^y^e^s^d^no
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^d
^f^o^r^Subs^idy⁰^%^N^A

^a^.^{RI us}^e^s^SCH^I^P^f^unds^{to e}^x^pa^{nd its}^c^o^m^p^re^he^ns^iv^e^Me^dic^aⁱ^{d Se}^c^{tion 1115 w}^a^iv^e^r^.^Cos^t^-s^ha^ring^is^pe^rm^itte^d
^unde^r^this^w^a^iv^e^r^.
^{b. T}^h^is^w^a^iv^e^r^a^llow^s^the^s^t^a^t^e^{to us}^e^SC^H^I^P^f^unds^{to c}^o^v^e^r^pa^r^e^nts^of^Me^dic^aⁱ^{d or}^SC^H^I^P^-^e^lig^ible^c^h^ildr^eⁿ^w^ith
^inc^o^m^e^be^tw^e^eⁿ^{100 a}^{nd 185%}^FP^L^,^a^{nd pr}^e^g^na^{nt w}^o^m^e^{n w}^{ith inc}^o^m^e^be^tw^e^eⁿ^185-^250%^FP^L^.
^c^.^T^h^e^SSP^’^s^s^o^le^pur^pos^e^is^{to pr}^ov^ide^pr^eⁿ^a^t^a^l^c^a^r^e^{to unbor}^{n c}^h^ildr^e^{n w}^{ith inc}^o^m^e^{up to 250%}^FP^L^.
^d^.^Eⁿ^ro^l^l^m^en^tⁱⁿ^RIt^e^S^h^are,^t^h^{e st}^at^{e’s p}^r^emⁱ^u^m^a^ssi^st^an^c^e^pr^og^r^a^m^,^is^m^a^nda^tor^y^f^o^r^Me^dic^aⁱ^d-^e^lig^ible
^indivⁱ^dua^ls^w^hos^e^e^m^ploy^e^r^s^of^f^e^r^e^{d a}ⁿ^a^ppr^ov^e^d^he^a^{lth pla}ⁿ^.

^Pr^o^g^r^a^m^In^fo
^Sta^t^e^{South Carolina.}^Me^dic^aⁱ^{d Ex}^pa^ns^{ion O}ⁿ^ly
^P^r^o^g^ram^Nam^e^P^a^rtn^e^{rs f}^o^{r Health}^y^Ch^ild^ren
^T^y^pe^O^f^P^r^og^r^a^m^M^e^d^ic^aⁱ^{d Ex}^pa^ns^ion
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^ise^A^f^f^e^c^ting^this
^Pr^o^g^r^a^mⁿ^o
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r^G^r^oups^N^o^t
^Elig^ible^f^o^{r this P}^r^og^ra^mⁿ^o
^Eligib^ility
^A^g^e^I^nc^om^e⁽^%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t¹⁵¹³³¹⁵⁰
^N^e^x^t^Y^oung^e^s^t⁶¹⁸¹⁰⁰¹⁵⁰
^Old^e^r
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregard^y^es
^A^{sset T}^e^stsⁿ^o
^Continuous^Elig^ibility^(m^onths⁾¹²
^P^r^e^s^um^ptiv^e^Elig^ibility^no
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿ^N^A
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^N^A
^Slidⁱⁿ^g^{Scale f}^o^{r Co}^st-Sh^a^rin^g^NA
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d^G^r^{oup 1}^G^r^{oup 2}^G^r^{oup 3}^G^r^{oup 4}
^Ran^g^{e (%}^FP^L⁾
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d
^Fa^m^ily^Ca^p
^Co^-Pa^y^m^e^nts
^C^o^-^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s
^Co^-P^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}^E^m^erg-Ro^o^m
^Co^-P^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}^E^m^erg-Ro^o^m
^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^Ty^p^e^N^A
^Option^N^A
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^{d-Out (m}^onths)⁰
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r^Subs^idy^N^A

^Pr^o^g^r^a^m^In^fo
^Sta^t^e^{South Dakota.}^Com^b^ina^tion
^P^r^o^g^ram^Nam^e^So^u^t^h^Dak^o^{ta CHIP}^CHIP^-NM
^T^y^p^e^Of^P^r^o^g^ram^M^edⁱ^cai^d^E^x^p^aⁿ^sⁱ^oⁿ^S^ep^arat^{e S}^t^at^{e P}^r^o^g^ram
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^ise^A^f^f^e^c^ting
^{this P}^r^og^ra^mⁿ^oⁿ^o
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r
^G^r^oups^N^o^{t Elig}^ible^f^o^r^this^P^r^og^r^a^mⁿ^oⁿ^o
^Eligib^ility
^A^g^e^I^nc^om^e⁽^%^FP^L⁾^A^g^e^I^nc^om^e⁽^%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t⁰⁵¹³³¹⁴⁰⁰¹⁸¹⁴⁰²⁰⁰
^N^e^x^t^Y^oung^e^s^t⁶¹⁸¹⁰⁰¹⁴⁰
^Old^e^r
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregard^y^es^y^e^s
^A^{sset T}^e^stsⁿ^oⁿ^o
^Continuous^Elig^ibility^(m^onths⁾⁰⁰
^P^r^e^s^um^ptiv^e^Elig^ibility^no^no
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿ^N^Aⁿ^o
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no^no
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^N^Aⁿ^o
^Slidⁱⁿ^g^{Scale f}^o^{r Co}^st-Sh^a^rin^g^NA^NA
^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d¹²³⁴¹²³⁴
^Ran^g^{e (%}^FP^L⁾
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d
^Fa^m^ily^Ca^p
^Co^-Pa^y^m^e^nts
^C^o^-^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s
^Co^-P^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}
^Em^e^r^g^-^R^oom
^Co^-P^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}
^Em^e^r^g^-^R^oom
^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^T^y^p^e^NA^S^ecret^ary^A^p^p^r^o^v^ed
^Op^tⁱ^oⁿ^N^A^S^am^{e as M}^e^dⁱ^cai^d
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^d-Out
⁽^m^onths⁾⁰³
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no^no
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^d
^f^o^r^Subs^idy^N^A^N^A

^Pr^o^g^r^a^m^In^fo
^Sta^t^e^Tennessee.^Me^dic^aⁱ^{d Ex}^pa^ns^{ion O}ⁿ^ly
^P^r^o^g^ram^Nam^e^T^eⁿⁿ^C^{are f}^o^{r Ch}^ild^ren
^T^y^pe^O^f^P^r^og^r^a^m^M^e^d^ic^aⁱ^{d Ex}^pa^ns^ion
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^ise^A^f^f^e^c^ting^this^a
^Pr^o^g^r^a^m^y^e^s
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r^G^r^oups^N^o^t
^Elig^ible^f^o^{r this P}^r^og^ra^mⁿ^o
^Eligib^ility
^A^g^e^I^nc^om^e⁽^%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t^bb^b^b
^N^e^x^t^Y^oung^e^s^t
^Old^e^r
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregard^y^es
^A^{sset T}^e^stsⁿ^o
^Continuous^Elig^ibility^(m^onths⁾⁰
^P^r^e^s^um^ptiv^e^Elig^ibility^no
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿ^N^A
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no^a
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^N^A^a
^Slidⁱⁿ^g^{Scale f}^o^{r Co}^st-Sh^a^rin^g^NA
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d^G^r^{oup 1}^G^r^{oup 2}^G^r^{oup 3}^G^r^{oup 4}
^Ran^g^{e (%}^FP^L⁾
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d
^Fa^m^ily^Ca^p
^Co^-Pa^y^m^e^nts
^C^o^-^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s
^Co^-P^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}^E^m^erg-Ro^o^m
^Co^-P^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}^E^m^erg-Ro^o^m
^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^T^y^pe^C^o^m^p^r^e^he^ns^iv^e^Me^dic^aⁱ^{d Se}^c^{tion 1115 w}^a^iv^e^r
^Option^N^A
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^{d-Out (m}^onths)⁰
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r^Subs^idy^N^A
^a^.^T^N^ha^{d us}^e^d^SC^H^I^P^f^unds^{to e}^x^pa^{nd its}^c^o^m^p^r^e^he^ns^iv^e^Me^dic^aⁱ^{d Se}^c^{tion 1115 w}^a^iv^e^r^{. A}^m^ong^othe^r^thing^s^,
^t^h^{e w}^aⁱ^v^{er gi}^{ves t}^h^{e st}^at^{e au}^t^h^o^rⁱ^t^y^t^o^cap^eⁿ^rollm^eⁿ^{t f}^o^{r c}^e^r^ta^{in e}^x^pa^{nsion e}^lig^ible^s.
^{b. T}^N^ha^{d us}^e^d^SCH^I^P^s^o^le^ly^{to c}^o^v^e^{r olde}^{r c}^h^ildre^{n in}^f^a^m^ilie^s^w^ith^inc^o^m^e^up^to^100%^FP^L^.^Sinc^e^a^{ll s}^u^c^h
^c^h^ildr^e^{n m}^u^s^t^be^c^o^v^e^r^e^{d by}^Me^dic^aⁱ^{d a}^s^of^O^c^{t. 1, 2002, T}^N^ha^s^{no SC}^H^I^P^eⁿ^r^o^llm^eⁿ^t.

^Pr^o^g^r^a^m^In^fo
^Sta^t^e^Texas.^Se^pa^ra^te^Sta^t^e^P^r^og^ra^m^Oⁿ^ly
^P^r^o^g^ram^Nam^e^CHIP^(P^h^a^{se II)}
^T^y^p^e^Of^P^r^o^g^ram^S^ep^arat^{e S}^t^at^{e P}^r^o^g^ram
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^ise^A^f^f^e^c^ting^this
^Pr^o^g^r^a^mⁿ^o
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r^G^r^oups^N^o^t
^Elig^ible^f^o^{r this P}^r^og^ra^mⁿ^o
^Eligib^ility
^A^g^e^I^nc^om^e⁽^%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t⁰¹¹⁸⁵²⁰⁰
^N^e^x^t^Y^oung^e^s^t¹⁵¹³³²⁰⁰
^O^l^de^r⁶¹⁸¹⁰⁰²⁰⁰
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregard^y^es
^A^{sset T}^e^stsⁿ^o
^Continuous^Elig^ibility^(m^onths⁾¹²
^P^r^e^s^um^ptiv^e^Elig^ibility^no
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿⁿ^o
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^y^es
^Sliding^Sc^a^l^e^f^o^{r Cost-Sha}^ring^inc^o^m^e
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d^G^r^{oup 1}^G^r^{oup 2}^G^r^{oup 3}^G^r^{oup 4}
^Ran^g^{e (%}^FP^L⁾¹⁰⁰¹⁵⁰¹⁸⁵¹⁵⁰¹⁸⁵²⁰⁰
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d^m^onthly^a
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d^a^$1⁵^$¹⁸
^Fa^m^ily^Ca^p^a^$1⁵^$¹⁸
^Co^-Pa^y^m^e^nts
^C^o^-^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s^$⁵^$²⁰^$²⁰
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s^$⁰^$⁵^$⁵
^Co^-P^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s^$²^$⁵^$¹⁰
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s^$²⁵^$⁵⁰^$¹⁰⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}^E^m^erg-Ro^o^m^$⁵^$⁵⁰^$⁵⁰
^C^o^-^P^a^y^m^e^{nt For}^N^on-^Em^e^r^g^U^s^e^O^f^Em^e^r^g^-^R^oom^$⁵^$⁵⁰^$⁵⁰
^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^T^y^pe^B^e^nc^hm^a^r^k^Equiv^a^le^nt
^Option^S^ta^te^Em^ploy^e^e
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^{d-Out (m}^onths)³
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r^Subs^idy^N^A
^a^.^Childre^{n in f}^a^m^ilie^s^w^{ith inc}^o^m^e^be^tw^e^eⁿ^100-150%^FP^L^pa^y^a^{$15 a}^nnua^{l e}ⁿ^rollm^eⁿ^{t f}^e^e^.

^Pr^o^g^r^a^m^In^fo
^Sta^t^e^Uta^h^.^Se^pa^ra^te^Sta^t^e^P^r^og^ra^m^Oⁿ^ly
^P^r^o^g^r^a^{m N}^a^me^U^t^a^h^C^H^I^P
^T^y^p^e^Of^P^r^o^g^ram^S^ep^arat^{e S}^t^at^{e P}^r^o^g^ram
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^ise^A^f^f^e^c^ting^this^no
^Pr^o^g^r^a^m
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r^G^r^oups^N^o^t^no
^Elig^ible^f^o^{r this P}^r^og^ra^m
^Eligib^ility
^A^g^e^I^nc^om^e⁽^%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t⁰⁵¹³³²⁰⁰
^N^e^x^t^Y^oung^e^s^t⁶¹⁸¹⁰⁰²⁰⁰
^Old^e^r
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregardⁿ^o
^A^{sset T}^e^stsⁿ^o
^Continuous^Elig^ibility^(m^onths⁾¹²
^P^r^e^s^um^ptiv^e^Elig^ibility^no
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿⁿ^o
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^y^e^s^a
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^y^es
^Sliding^Sc^a^l^e^f^o^{r Cost-Sha}^ring^inc^o^m^e
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d^G^r^{oup 1}^G^r^{oup 2}^G^r^{oup 3}^G^r^{oup 4}
^Ran^g^{e (%}^FP^L⁾¹⁰⁰¹⁵⁰¹⁵⁰²⁰⁰
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d^qua^r^t^e^r^ly
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d^$¹³^$²⁵
^Fa^m^ily^Ca^p^$¹³^$²⁵
^Co^-Pa^y^m^e^nts
^Co-P^a^y^m^e^{nt For Bra}^{nd N}^a^m^e^Rx^D^r^ug^s^$²^b^{$ 5}^b
^Co-P^a^y^m^e^{nt For G}^e^ne^ric^Rx^D^r^ug^s^$²^b^{$ 5}^b
^Co^-P^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s^$⁵^$¹⁵
^10%^of^c
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s^$⁵^a^llow^e^{d a}^m^t
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}^E^m^erg-Ro^o^m^$⁵^$³⁵
^C^o^-^P^a^y^m^e^{nt For}^N^on-^Em^e^r^g^U^s^e^O^f^Em^e^r^g^-^R^oom^$¹⁰^$³⁵
^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^T^y^pe^B^e^nc^hm^a^r^k^Equiv^a^le^nt
^Option^S^ta^te^Em^ploy^e^e
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^{d-Out (m}^onths)³
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r^Subs^idy^N^A
^a^.^A^c^a^p^of^{24,000 w}^a^s^im^pos^e^d^by^aⁿ^a^m^e^ndm^eⁿ^{t a}^ppr^ov^e^d^by^C^M^{S in J}^une^2002.
^{b. A}^m^ounts^s^how^{n a}^r^e^f^o^r^dr^ug^s^on^the^s^t^a^t^e^’^s^pr^e^f^e^r^r^e^d^dr^ug^lis^t.^C^o^-^p^a^y^m^e^nts^a^r^e^hig^h^e^r^f^o^r^dr^ug^s^{not on this}
^lis^{t: $5 f}^o^r^c^h^ildr^e^{n w}^{ith inc}^o^m^e^be^tw^e^eⁿ^100-^150%^FP^L^a^{nd 50%}^of^the^c^o^s^t^of^the^dr^ug^f^o^r^c^h^ildr^e^{n w}^ith
^inc^o^m^e^be^tw^e^eⁿ^150-^200%^FP^L^.
^c^.^T^h^e^a^llow^e^{d a}^m^{ount is}^the^bille^{d c}^h^a^r^g^e^s^le^s^s^25%^.

^Pr^o^g^r^a^m^In^fo
^Sta^t^e^Vermont.^Se^pa^ra^te^Sta^t^e^P^r^og^ra^m^Oⁿ^ly
^P^r^o^g^ram^Nam^e^Dr.^Dyⁿ^a^sau^r
^T^y^p^e^Of^P^r^o^g^ram^S^ep^arat^{e S}^t^at^{e P}^r^o^g^ram
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^ise^A^f^f^e^c^ting^this
^Pr^o^g^r^a^mⁿ^o
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r^G^r^oups^N^o^t
^Elig^ible^f^o^{r this P}^r^og^ra^mⁿ^o
^Eligib^ility
^A^g^e^I^nc^om^e⁽^%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t⁰¹⁷²²⁵³⁰⁰
^N^e^x^t^Y^oung^e^s^t
^Old^e^r
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregard^y^es
^A^{sset T}^e^stsⁿ^o
^Continuous^Elig^ibility^(m^onths⁾¹²^a
^P^r^e^s^um^ptiv^e^Elig^ibility^no
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿⁿ^o
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^y^es
^Slidⁱⁿ^g^{Scale f}^o^{r Co}^st-Sh^a^rin^gⁿ^o
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d^G^r^{oup 1}^G^r^{oup 2}^G^r^{oup 3}^G^r^{oup 4}
^Ran^g^{e (%}^FP^L⁾²²⁵³⁰⁰
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d^m^onthly^b
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d^$⁵⁰
^Fa^m^ily^Ca^p^$⁵⁰
^Co^-Pa^y^m^e^nts
^C^o^-^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s^$⁰
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s^$⁰
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}^E^m^erg-Ro^o^m^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}^E^m^erg-Ro^o^m^$⁰
^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^T^y^p^e^S^ecret^ary^A^p^p^r^o^v^ed
^Op^tⁱ^oⁿ^S^am^{e as M}^e^dⁱ^cai^d
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^{d-Out (m}^onths)¹
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r^Subs^idy^N^A
^a^.^H^o^w^e^v^e^r^,^a^pa^r^e^nt’^s^eⁿ^r^o^llm^eⁿ^{t in one}^of^Ve^r^m^ont’^s^s^t^a^t^e^-^only^f^unde^d^he^a^{lth pr}^og^r^a^m^s^f^o^r^a^dults^mⁱ^g^h^{t r}^e^s^u^lt
^{in a}^s^horte^{r pe}^{riod of}^c^ontinuous^e^lig^ibility^{, due}^{to the}^othe^{r prog}^ra^m^s^’^m^o^{re fr}^eq^u^eⁿ^t^e^lig^ibility
^r^e^de^te^r^m^ina^{tion f}^o^r^pa^r^e^nts^.
^{b. T}^h^e^m^onthly^prog^ra^m^f^e^e^{is bille}^{d qua}^rte^r^ly^.

^Pr^o^g^r^a^m^In^fo
^Sta^t^e^Virginia.^Com^b^ina^tion
^F^a^mⁱ^l^y^A^{ccess t}^o^M^e^dⁱ^cal^F^a^mⁱ^l^y^A^{ccess t}^o^M^e^dⁱ^cal
^In^su^ran^{ce S}^ecu^ri^t^y^P^l^an^In^su^ran^{ce S}^ecu^ri^t^y^P^l^an
^P^r^o^g^r^a^{m N}^a^me^(FA^M^{IS) P}^l^u^s^(FA^M^IS)
^T^y^p^e^Of^P^r^o^g^ram^M^edⁱ^cai^d^E^x^p^aⁿ^sⁱ^oⁿ^S^ep^arat^{e S}^t^at^{e P}^r^o^g^ram
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^ise^A^f^f^e^c^ting^this
^Pr^o^g^r^a^mⁿ^oⁿ^o
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r
^G^r^oups^N^o^{t Elig}^ible^f^o^r^this^P^r^og^r^a^mⁿ^oⁿ^o
^Eligib^ility
^In^co^m^e^In^co^m^e
^Ag^e^(%^FP^L⁾^A^g^e^(%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t⁶¹⁸¹⁰⁰¹³³⁰¹⁸¹³³²⁰⁰
^N^e^x^t^Y^oung^e^s^t
^Old^e^r
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregard^y^esⁿ^o
^A^{sset T}^e^stsⁿ^oⁿ^o
^Continuous^Elig^ibility^(m^onths⁾⁰⁰
^P^r^e^s^um^ptiv^e^Elig^ibility^no^no
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿ^N^Aⁿ^o
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no^no
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^N^A^y^es
^Sliding^Sc^a^l^e^f^o^{r Cost-Sha}^ring^NA^inc^o^m^e
^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup^G^r^oup
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d¹²³⁴¹²³⁴
^Ran^g^{e (%}^FP^L⁾¹⁰⁰¹⁵⁰¹⁵⁰²⁰⁰
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d^no
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d
^Fa^m^ily^Ca^p
^Co^-Pa^y^m^e^nts^a
^C^o^-^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s^$²^$⁵
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s^$²^$⁵
^C^o^-^P^a^y^m^e^{nt For}^O^f^fⁱ^c^e^Vis^its^$2^$5
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s^$15^$25
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}
^Em^e^r^g^-^R^oom^$0^$0
^Co^-P^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}
^Em^e^r^g^-^R^oom^$10^$25
^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^T^y^p^e^NA^S^ecret^ary^A^p^p^r^o^v^ed
^NA^S^t^at^{e E}^m^p^l^o^y^{ee an}^d^S^a^m^e^as^a
^Option^M^e^dⁱ^cai^d
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^d-Out
⁽^m^onths⁾⁰⁶
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^y^e^s^b^ye^s^c
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r
^Subs^idy⁰^%^40%

^{a. Ch}^ild^ren^en^ro^lledⁱⁿ^{a M}^aⁿ^a^g^e^d^Care^En^tity^(M^{CE) receiv}^e^co^v^e^rag^e^b^a^sed^{upon the}^s^t^a^t^e^e^m^ploy^e^e^he^a^lth
^plaⁿ^{. C}^h^ildr^eⁿⁱⁿ^g^e^og^r^a^phic^a^r^e^a^s^w^ithout^s^u^c^h^aⁿ^MC^{E obta}ⁱ^{n s}^e^r^v^ic^e^s^thr^oug^{h a}^P^r^im^a^r^y^C^a^r^e^C^a^s^e
^Ma^na^g^e^m^e^{nt (P}^{CCM) prog}^ra^m^tha^t^prov^ide^s^be^ne^f^{its si}^m^ila^{r to Me}^dic^aⁱ^{d, until suc}^h^aⁿ^{MCE is a}^v^a^ila^ble^.
^C^o^-^p^a^y^m^e^nts^a^pply^only^{to MC}^{E c}^h^ildr^e^n.
^b^.^F^A^M^I^S^P^l^u^s^Chⁱ^l^d^ren^w^h^o^s^{e p}^a^ren^t^{s h}^a^{ve access t}^o^em^p^l^o^y^er-s^pons^or^e^d^ins^u^r^a^nc^e^w^{ith de}^pe^nde^{nt c}^o^v^e^r^a^g^e
^m^u^st^ap^p^l^y^f^o^{r su}^ch^co^verage.
^c.^F^A^M^I^S^Chⁱ^l^d^ren^w^h^o^s^{e p}^a^ren^t^{s h}^a^{ve access t}^o^em^p^l^o^y^er-s^pons^or^e^d^ins^u^r^a^nc^e^tha^t^is^c^o^s^t^-^e^f^f^e^c^tiv^e^a^{nd tha}^t
^m^eet^{s t}^h^{e b}^eⁿ^e^fⁱ^t^s^q^u^a^lⁱ^fⁱ^catⁱ^oⁿ^s^h^a^{ve t}^h^e^optⁱ^{on of}^recei^viⁿ^g^t^h^{e su}^b^sⁱ^d^y^f^o^{r em}^p^l^o^y^er-s^pons^or^e^d^c^o^v^e^r^a^g^e
^{or e}ⁿ^rolling^{in the}^sta^t^e^’^{s pla}ⁿ^.^{No c}^o^-pa^y^{s a}^pply^{to suc}^h^c^h^ildre^n.

^Pr^o^g^r^a^m^In^fo
^Sta^t^e^Washington.^Se^pa^ra^te^Sta^t^e^P^r^og^ra^m^Oⁿ^ly
^P^r^og^r^a^m^N^a^m^e^W^a^s^h^ing^t^{on Sta}^t^e^C^H^I^P
^T^y^p^e^Of^P^r^o^g^ram^S^ep^arat^{e S}^t^at^{e P}^r^o^g^ram
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^ise^A^f^f^e^c^ting^this
^Pr^o^g^r^a^mⁿ^o
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r^G^r^oups^N^o^t
^Elig^ible^f^o^{r this P}^r^og^ra^mⁿ^o
^Eligib^ility
^A^g^e^I^nc^om^e⁽^%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t⁰¹⁸²⁰⁰²⁵⁰
^N^e^x^t^Y^oung^e^s^t
^Old^e^r
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregard^y^es
^A^{sset T}^e^stsⁿ^o
^Continuous^Elig^ibility^(m^onths⁾¹²
^P^r^e^s^um^ptiv^e^Elig^ibility^no
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿⁿ^o
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^y^es
^Slidⁱⁿ^g^{Scale f}^o^{r Co}^st-Sh^a^rin^gⁿ^o
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d^G^r^{oup 1}^G^r^{oup 2}^G^r^{oup 3}^G^r^{oup 4}
^Ran^g^{e (%}^FP^L⁾²⁰⁰²⁵⁰
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d^m^onthly
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d^$¹⁰
^Fa^m^ily^Ca^p^$³⁰
^Co^-Pa^y^m^e^nts
^C^o^-^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s^$⁰
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s^$⁰
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}^E^m^erg-Ro^o^m^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}^E^m^erg-Ro^o^m^$⁰
^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^T^y^p^e^S^ecret^ary^A^p^p^r^o^v^ed
^Op^tⁱ^oⁿ^S^am^{e as M}^e^dⁱ^cai^d
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^{d-Out (m}^onths)⁴
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r^Subs^idy^N^A

^Pr^o^g^r^a^m^In^fo
^Sta^t^e^{West Virginia.}^Se^pa^ra^te^Sta^t^e^P^r^og^ra^m^Oⁿ^ly
^P^r^o^g^ram^Nam^e^W^e^{st V}ⁱ^rgⁱⁿ^{ia CHIP}^(P^h^a^{se III)}
^T^y^p^e^Of^P^r^o^g^ram^S^ep^arat^{e S}^t^at^{e P}^r^o^g^ram
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^ise^A^f^f^e^c^ting^this
^Pr^o^g^r^a^mⁿ^o
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r^G^r^oups^N^o^t
^Elig^ible^f^o^{r this P}^r^og^ra^mⁿ^o
^Eligib^ility
^A^g^e^I^nc^om^e⁽^%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t⁰¹¹⁵⁰²⁰⁰
^N^e^x^t^Y^oung^e^s^t¹⁵¹³³²⁰⁰
^O^l^de^r⁶¹⁸¹⁰⁰²⁰⁰
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregard^y^es
^A^{sset T}^e^stsⁿ^o
^Continuous^Elig^ibility^(m^onths⁾¹²
^P^r^e^s^um^ptiv^e^Elig^ibility^no
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿⁿ^o
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^y^es
^Sliding^Sc^a^l^e^f^o^{r Cost-Sha}^ring^inc^o^m^e
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d^G^r^{oup 1}^G^r^{oup 2}^G^r^{oup 3}^G^r^{oup 4}
^Ran^g^{e (%}^FP^L⁾¹⁰⁰¹⁵⁰¹⁵⁰²⁰⁰
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d^no
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d
^Fa^m^ily^Ca^p
^Co^-Pa^y^m^e^nts
^C^o^-^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s^a^$5/$5^$10/$15
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s^$⁰^$¹⁵
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s^$⁰^$²⁵
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}^E^m^erg-Ro^o^m^$⁰^$³⁵
^Co^-P^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}^E^m^erg-Ro^o^m^$⁰^$³⁵
^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^T^y^pe^B^e^nc^hm^a^r^k^Equiv^a^le^nt
^Option^S^ta^te^Em^ploy^e^e
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^{d-Out (m}^onths)⁶
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r^Subs^idy^N^A
^a^.^A^m^ounts^s^how^{n a}^r^e^f^o^r^br^a^nd-^na^m^e^dr^ug^s^tha^t^a^r^e^/^a^r^e^{not on the}^s^t^a^t^e^’^s^pr^e^s^c^r^{iption dr}^ug^f^o^r^m^ula^r^y^.

^Pr^o^g^r^a^m^In^fo
^Sta^t^e^Wisconsin.^Me^dic^aⁱ^{d Ex}^pa^ns^{ion O}ⁿ^ly
^P^r^o^g^r^a^{m N}^a^me^B^a^d^g^e^r^C^a^r^e
^T^y^pe^O^f^P^r^og^r^a^m^M^e^d^ic^aⁱ^{d Ex}^pa^ns^ion
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^ise^A^f^f^e^c^ting^this^a
^Pr^o^g^r^a^m^y^e^s
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r^G^r^oups^N^o^t^b
^Elig^ible^f^o^{r this P}^r^og^ra^m^y^e^s
^Eligib^ility
^A^g^e^I^nc^om^e⁽^%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t⁶¹⁸¹⁰⁰¹⁸⁵
^N^e^x^t^Y^oung^e^s^t
^Old^e^r
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregard^y^es
^A^{sset T}^e^stsⁿ^o
^Continuous^Elig^ibility^(m^onths⁾⁰
^P^r^e^s^um^ptiv^e^Elig^ibility^no
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿ^N^A
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^y^es
^Sliding^Sc^a^l^e^f^o^{r Cost-Sha}^ring^inc^o^m^e
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d^G^r^{oup 1}^G^r^{oup 2}^G^r^{oup 3}^G^r^{oup 4}
^Ran^g^{e (%}^FP^L⁾¹⁰⁰¹⁵⁰¹⁵⁰¹⁸⁵
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d^m^onthly
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d^$⁰^3%^of^f^a^m^ily
^inc^o^m^e^c^Fa^m^ily^Ca^p^$⁰
^Co^-Pa^y^m^e^nts
^C^o^-^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s^$⁰^$⁰
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}^E^m^erg-Ro^o^m^$⁰^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}^E^m^erg-Ro^o^m^$⁰^$⁰
^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^T^y^pe^C^o^m^p^r^e^he^ns^iv^e^Me^dic^aⁱ^{d Se}^c^{tion 1115 w}^a^iv^e^r
^Option^N^A
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^{d-Out (m}^onths)³
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^y^e^s^d
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r^Subs^idy^40%^d
^a^.^W^I^us^e^s^SC^H^I^P^f^unds^to^e^x^pa^nd^its^c^o^m^p^r^e^he^ns^iv^e^Me^dic^aⁱ^{d Se}^c^{tion 1115 w}^a^iv^e^r^unde^r^w^h^ic^{h c}^o^s^t^-^s^ha^rⁱ^ng
^{is pe}^rm^itte^d.
^{b. T}^h^e^SC^H^I^P^w^a^iv^e^r^c^o^v^e^r^s^pa^r^e^nts^of^SC^H^I^P^a^{nd Me}^dic^aⁱ^{d c}^h^ildr^e^{n w}^{ith inc}^o^m^e^be^tw^e^eⁿ^100-^185%^FP^L^.
^c^.^P^r^e^m^ium^s^a^r^e^pa^{id on be}^ha^lf^of^the^f^a^m^ily^{. T}^h^e^low^e^s^t^pos^sⁱ^ble^pr^e^m^ium^is^{$30 pe}^r^f^a^m^ily^pe^r^m^onth.
^d^.^Chⁱ^l^d^ren^w^h^o^s^{e p}^a^ren^t^{s h}^a^{ve access t}^o^em^p^l^o^y^er-s^pons^or^e^d^ins^u^r^a^nc^e^tha^t^is^c^o^s^t^-^e^f^f^e^c^tiv^e^a^{nd tha}^t^m^e^e^t^s^the
^be^ne^f^its^qua^lif^ic^a^tions^m^u^s^t^eⁿ^r^o^{ll i}ⁿ^the^e^m^ploy^e^r^plaⁿ^f^o^r^f^a^m^ily^c^o^v^e^r^a^g^e^{. T}^o^qua^lif^y^,^the^e^m^ploy^e^r
^m^u^s^t^pa^y^a^t^le^a^s^{t 40%}^{, but le}^s^s^thaⁿ^80%^{, of}^a^f^a^m^ily^pr^e^m^ium^.

^Pr^o^g^r^a^m^In^fo
^Sta^t^e^Wy^oming.^Se^pa^ra^te^Sta^t^e^P^r^og^ra^m^Oⁿ^ly
^P^r^o^g^ram^Nam^e^Kid^{Care CHIP}
^T^y^p^e^Of^P^r^o^g^ram^S^ep^arat^{e S}^t^at^{e P}^r^o^g^ram
^St^a^t^e^H^a^s^{1115 W}^a^iv^e^r^:
^W^a^iv^ing^P^r^ov^{isions Othe}^rw^ise^A^f^f^e^c^ting^this
^Pr^o^g^r^a^mⁿ^o
^A^llowⁱ^ng^U^s^e^of^SC^H^I^P^Funds^{to C}^o^v^e^r^G^r^oups^N^o^t
^Elig^ible^f^o^{r this P}^r^og^ra^mⁿ^o
^Eligib^ility
^A^g^e^I^nc^om^e⁽^%^FP^L⁾
^L^o^w^e^r^U^ppe^r^L^ow^e^r^U^ppe^r
^Y^oung^e^s^t⁰⁵¹³³¹⁸⁵
^N^e^x^t^Y^oung^e^s^t⁶¹⁸¹⁰⁰¹⁸⁵
^Old^e^r
^Old^e^st
^Basi^{c In}^co^m^e^Di^sregard^y^es
^A^{sset T}^e^stsⁿ^o
^Continuous^Elig^ibility^(m^onths⁾¹²
^P^r^e^s^um^ptiv^e^Elig^ibility^no
^P^r^eⁿ^a^t^a^l^C^a^r^e^f^o^r^U^nbor^{n C}^h^ildr^eⁿⁿ^o
^Enrollm^eⁿ^{t Ca}^{p / W}^a^iting^Lⁱ^st^no
^{Cost S}^h^arin^g
^Co^{st Sh}^arin^g^Req^uⁱ^red^y^es
^Slidⁱⁿ^g^{Scale f}^o^{r Co}^st-Sh^a^rin^gⁿ^o
^{Sliding Sc}^ale^G^r^{oup D}^e^fⁱ^ne^d^G^r^{oup 1}^G^r^{oup 2}^G^r^{oup 3}^G^r^{oup 4}
^Ran^g^{e (%}^FP^L⁾¹⁰⁰¹⁸⁵
^Pre^m^ium^{or Enrollm}^eⁿ^{t Fe}^e^Re^quire^d^no
^P^r^emⁱ^u^m^/^F^{ee P}^e^{r Ch}ⁱ^l^d
^Fa^m^ily^Ca^p
^Co^-Pa^y^m^e^nts
^C^o^-^P^a^y^m^e^{nt For}^B^r^a^{nd N}^a^m^e^R^x^D^r^ug^s^$⁵
^Co^-P^ay^m^eⁿ^t^Fo^{r G}^eⁿ^e^{ric Rx}^Dru^g^s^$³
^Co^-P^ay^m^eⁿ^t^F^o^{r Of}^fⁱ^{ce V}ⁱ^si^t^s^$⁵
^C^o^-^P^a^y^m^e^{nt For}^I^npa^tie^{nt Se}^r^v^ic^e^s^$⁰
^Co^-P^ay^m^eⁿ^t^F^o^{r E}^m^{erg Use Of}^E^m^erg-Ro^o^m^$⁵
^Co^-P^ay^m^eⁿ^t^F^o^{r No}ⁿ^-^E^m^{erg Use Of}^E^m^erg-Ro^o^m^$⁵
^C^ove^r^a^g^e^T^y^pe^/^O^ptⁱ^oⁿ
^T^y^p^e^S^ecret^ary^A^p^p^r^o^v^ed
^Option^O^the^r
^Rel^a^ti^on^shⁱ^p^{To P}^rⁱ^vate/^Oth^{er Coverag}^e
^W^a^iting^P^e^{riod to P}^r^e^v^eⁿ^{t Crow}^{d-Out (m}^onths)
⁽^m^onths⁾¹
^Subs^idy^For^P^r^iv^a^t^e^/^Em^ploy^e^r^C^o^v^e^r^a^g^e^no
^{Min. Em}^ploy^e^r^P^r^e^m^ium^Sha^r^e^R^e^quir^e^{d f}^o^r^Subs^idy^N^A