SCHIP
overview
|
Milestones - Healthcare under the SCHIP
program began on February 1, 2000
Eligibility
Children under 19 in families with
"countable" income between 200% and 250% of the federal
poverty level (FPL)
This is a monthly income
between $3,535 and $4,417 per month
(effective 4/1/08) for a family of four
"Countable" income means we allow the same income deductions as the children’s Medicaid program
Children who are eligible for
Medicaid are not eligible for SCHIP
Children cannot have other insurance that provides access to
doctors, hospitals, laboratory services and radiology services
If
the
family dropped employer sponsored dependent
coverage, the child must wait 4 months
before enrolling in SCHIP. Exceptions to this policy are listed below under "Exceptions to
Waiting Period."
Children are covered for
up to 6 months. Coverage may end during the 6 months if the children
move out of state, turn 19 years old, their income goes up, or monthly
premiums are not paid.
Application Process
- There is a single application for
both Medicaid
and SCHIP
- When a family submits an application for benefits:
- We need information on whether a child has other
insurance coverage, or whether
the family dropped employer sponsored dependent
coverage
Scope of Services
- Same as covered under Medicaid's Categorically Needy
(CNP) program
Service Delivery
- Services are covered
from the beginning of the month in which the application was received
- Fee-for-service (no health care plan) is used
before managed care starts
- Managed care
-
Clients
are required to enroll in managed care if they live in counties with
two or more plans.
- Clients have voluntary managed care enrollment if they live in counties with only 1 plan
- Clients will get their care through fee-for-service
in counties with no plans
(Asotin county only)
American Indian/Alaska Natives have the same
choice of health plans plus Primary
Care Case Manager Indian clinics or fee-for-service (no health care plan)
Client Cost Sharing
Clients are required to pay monthly
premiums, unless they are an
American Indian or Alaska Native.
- $15 per child/per month, $45 family maximum per month
Clients will be disenrolled if payments are
not made for 3 months and must wait 3 months before they can become
eligible again.
Exceptions to Waiting Period
If a
family dropped employer-sponsored health care there is a 4-month waiting
period to be eligible for SCHIP. There is no waiting period if the
family has one of the following exceptions:
The client or family member has a medical condition that, without
treatment would be life-threatening or cause serious disability or loss of function; or
The loss of employer sponsored dependent coverage is due to any of
the following;
Loss of employment;
Death of the employee;
The employer discontinues employer-sponsored dependent coverage;
The family's total out-of-pocket maximum for employer-sponsored
dependent coverage is fifty dollars per month or more;
The plan terminates employer-sponsored dependent coverage for the
client because the client reached the maximum lifetime coverage amount;
Coverage under a COBRA extension period expired;
Employer-sponsored dependent coverage is not reasonably available
(e.g., client would have to travel to another city or state to access care); or
Domestic violence that leads to loss of coverage for the victim.
Return to SCHIP Homepage
|
| Questions about
SCHIP?
Ask SCHIP |
For comments or questions regarding (your program here), email
contact us.
Modified:
Monday, April 21, 2008.
Send comments or questions about this site to the
HRSA Webmaster
For more ways to get in touch with the Department of Social and Health
Services go to the
DSHS Contact
Information Web page.
Technical Site Comments:
DSHS Webmaster.
