Exhibit 4: Cost-Sharing Provisions in States’ CHIP Programs

 
  Alabama Colorado Massachusetts New York Ohio Oregon
Premiums None, if family income < 150% FPL

>150% FPL, annual premium =$50/child* capped at $150 per family

None, if family income <100% FPL

100-149% FPL=

$9/child with

$15/family cap

150-169% FPL=

$15/child with

$25/family cap

170-185% FPL=

$20/child with

$30/family cap

>185% FPL=

full premium is 

proposed

$10/child1 None if family income <160% FPL

160-222% FPL=

$9/child with

$27/family cap

223-230% FPL=

$15/child with

$45/family cap

Families with income above 230% FPL can purchase CHPlus for about $1000/child annually1

Under consideration for Phase II None
Co-payments None, if family income <150% FPL

Family Income

>150% FPL=

$5 most services;

$1 for generic 

prescriptions

$3 for brand name 

prescriptions

None, if family income <100%FPL

100-150%FPL=

$2 most services,

$1 for generic 

prescriptions,

$5 for brand name 

prescriptions

151-185%FPL=

$5 most services;

$3 for generic 

prescriptions,

$5 for brand name 

prescriptions

None in Family Assistance Plan direct coverage None Under consideration for Phase II None

* $60/child if paid in installments, and capped at $180/family