OVERVIEW

1
OVERVIEW

• Role of Cost-Sharing
• Experience With Cost-Sharing in Child Health Plus
• Premiums
• Copayments
• Assessing Our Cost-Sharing Choices

2
ROLE OF COST-SHARING

• Deter Unnecessary Utilization
• Encourage Personal Responsibility
• Defray the Cost of the Subsidy
• Reduce Substitution of Private Coverage

3
OVERVIEW OF CHILD HEALTH PLUS

• State Subsidized Health Insurance Program for
  Children Between 100 and 222 of Poverty
• Benefits Include Primary and Acute Care
• Families Are Responsible for Small Premium
  Contributions and Copayments
• Health Insurance Is Provided Through Managed Care
  Plans

4
EXPERIENCE WITH COST-SHARING IN CHILD HEALTH PLUS

• Premium Contributions
• Copayments

5
DRIVING FACTORS IN SETTING PREMIUM CONTRIBUTIONS

• Promote Personal Responsibility
• Encourage Purchase of Coverage
• Deter Substitution of Private Coverage
• Align With Other States Cost-Sharing Requirements

6
PREMIUM COST-SHARING IN CHILD HEALTH PLUS
7
IMPLEMENTATION OF COST-SHARING

• Insurers Determine Eligibility and Enroll
  Families in Child Health Plus
• Insurers Collect a Monthly Premium Contribution
  From Families

8
CHILDREN ENROLLED IN CHILD HEALTH PLUS
9
ISSUES IN LEGISLATIVE DEBATE ON PREMIUM
CONTRIBUTIONS

• At What Income Level Should Premium Contributions
  Begin?
• What Amount of Cost-Sharing Is Both Affordable
  and Does Not Encourage Crowd-Out?
• How Should Premium Contributions Be Adjusted for
  Family Size?

10
EXPERIENCE WITH COPAYMENTS IN CHILD HEALTH PLUS

• Most Utilization Control Is Left to the Managed
  Care Plan
• Copayments Are Used for Services Only Where
  Additional Utilization Controls Seem Necessary
• Outpatient visits
• Prescription drugs
• Emergency room visits
• Implementation of Title XXI Limit on
  Out-of-Pocket Spending Is Creating Challenges

11
ASSESSING OUR COST-SHARING CHOICES

• Examine Enrollment by Income Level
• Analyze Utilization by Income Level
• Assess Reasons for Disenrollment
• Analyze Extent of Crowd-Out and Reasons for
  Dropping Private Coverage