Children's Health Insurance Expansions: State Experiences in Developing Benefit Packages and Cost-Sharing Arrangements

Contract #100-96-0011
Delivery Order No. 2
Final Report

Submitted To:
The Office of the Assistant Secretary for Planning and Evaluation
Office of Health Policy
U.S. Department of Health and Human Services

 

February 17, 1998

TABLE OF CONTENTS

Executive Summary

I. Introduction

A. Decisions Regarding the Design of State Benefit Packages and Cost-Sharing Arrangements under Title XXI

1. Children's Benefit Packages Under Medicaid

2. Non-Medicaid Options for Benefit Packages Under Title XXI

3. Cost-Sharing Requirements Under Title XXI

B. Study Approach

 

II. Overview of Programs Reviewed

B. Stand-alone Insurance Programs: California, Colorado, Florida, Massachusetts, New York, and Pennsylvania

 

III. Benefit Design

A. Designing a Benefit Package

Objective 1: Providing a comprehensive Medicaid benefit package

Objective 2: Providing preventive services to as many children as possible

Objective 3: Providing coverage for a specific population of uninsured children

B. The Debates Over Inpatient, Vision, Dental, and Hearing Benefits

 

IV. State Approaches to Cost-sharing

A. Cost-sharing Mechanisms Used by the States

B. Reasons for Imposing Cost-sharing

C. Addressing Price Sensitivity

D. Selection of Sliding Scales or Flat Rates

E. Other Factors Determining Premiums and Cost-Sharing

F. The Impact of Premiums and Copayments on Substitution

G. The Role of Administrative Costs in Developing Approaches to Cost-sharing

 

V. Conclusion

Attachment A: Sliding Scale Examples

 

Attachment B: Overview of State Programs