Attachment A: Sliding Scale Examples
Table 6: TennCare Premium Sliding Scale
| Family Monthly Premium | $0 | $24.50 | $32.25 | $47.50 | $70.50 | $183.50 | $200.75 |
| Percentage of Poverty | 0-100% | 101-119% | 120-139% | 140-169% | 170-199% | 200-209% | 210-219% |
Table 7: NY Child Health Plus Premium Sliding Scale
| Monthly Premium | $0 | $9 per child up to family maximum of $36 | $13 per child up to family maximum of $52 | Full premium: $58-99 per member |
| Percentage of Poverty | 0-120% | 120-159% | 160-222% | +222% |
Table 8: MA Children's Medical Security Plan Premium Sliding Scale
| Monthly Premium | $0 | $10.50 per child up to family maximum of $31.50 | Full premium $52.50 per child |
| Percentage of Poverty | 0-200% | 201-400% | +400% |
Table 9: FL Healthy Kids Corporation Premium Sliding Scale
| County | Volusia | Dade | Santa Rosa | Hardee |
| Free Lunch | $10 | $10 | $5 | $5 |
| Reduced Lunch | $25 | $20 | $15 | $13 |
| Not on Lunch Program | $48 | $51 | $53 | $49 |
Table 10: PA BlueCHIP Premium Sliding Scale
| Grantee and Region | Free | Subsidized | State Share Subsidized |
| Central CBC/KHPC CBC/KHPC KHPC & USHC |
$63 46.44 52.23 |
$81.90 60.37 67.90 |
$40.95 30.19 33.95 |
| Northeast BCNEPA First Priority Health |
$59.14 59.14 |
$76.88 76.88 |
$38.44 38.44 |
| Southeast USHC & KHPE |
$52.23 |
$67.90 |
$33.95 |
| Western KHPW USHC & KHPW BCWPA |
$64.25 51.77 62.50 |
$83.53 67.30 81.25 |
$41.77 33.65 40.63 |
Abbreviations: BCNEPA, Blue Cross Northeast PA (Caring Foundation of Northeastern PA); BCWPA, Blue Cross Western PA (Western PA Caring Foundation); CBC, Capital Blue Cross (Caring Foundation of Central PA); First Priority Health, Caring Foundation of Northeastern PA; KHPC, Keystone Health Plan Central (Caring Foundation of Central PA); KHPE, Keystone Health Plan East (Independence Blue Cross & PA Blue Shield); KHPW, Keystone Health Plan West (Western PA Caring Foundation); USHC, U.S. Healthcare.
Table 11: MinnesotaCare Premium Sliding Scale
| Percentage of Poverty | Premium Contribution by Number Covered | ||
| 1 | 2 | 3 | |
| 0-62% | $4 | $8 | $12 |
| 62-89 | 5-7 | 10-14 | 15-21 |
| 89-115 | 9-12 | 18-23 | 28-35 |
| 115-142 | 16-19 | 32-39 | 48-58 |
| 142-168 | 24-28 | 49-57 | 73-85 |
| 168-195 | 36-41 | 73-83 | 109-124 |
| 195-221 | 52-58 | 103-116 | 155-174 |
| 221-248 | 74-82 | 147-163 | 221-245 |
| 248-275 | 98-128 | 196-255 | 294-383 |
Table 12: Oregon Health Plan Premium Sliding Scale
| Percentage of Poverty | Number of Non-Exempt HPNs in the Benefit Group |
||||||
| 0 | 1 | 2 | 3 | 4 or More | |||
| 0-50% | 0 | $6 | $6.50 | $7 | $7.50 | ||
| 50-65% | 0 | 15 | 18 | 20 | 22 | ||
| 65-85% | 0 | 18 | 21 | 24 | 26 | ||
| 85-100% | 0 | 20 | 23 | 26 | 28 | ||