Children's Health Insurance Expansions: State Experiences in Developing Benefit Packages and Cost-Sharing Arrangements. Decisions Regarding the Design of State Benefit Packages and Cost-Sharing Arrangements under Title XXI


The programmatic options afforded to states through Title XXI will require states to examine their overall objectives in providing children's coverage. Some states may select Medicaid, while other states may select one of the benefit packages specified in the legislation as the most feasible and appropriate model for their population. Other states may decide they want to provide a more comprehensive benefit package than those specified in the legislation. The degree to which benefit packages exceed those standards outlined in the Federal legislation will be based on judgments by the states regarding the relative importance and affordability of particular health services. States must also determine cost-sharing within specific legislatively defined parameters. Based on the experiences of the state programs reviewed in this paper, these decisions are likely to reflect specific state program objectives. These objectives may include using cost-sharing as a means of offsetting cost, a method for instilling a sense of responsibility in participants, a way to modify participants' behavior (e.g., discourage emergency room use), and a method for limiting the potential for substitution.