Premium Dental Benefits Note Separate Children to 19 years of age in families with income up to 200% of the FPL

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1 Status Report on State Child Health Insurance Program (SCHIP) Implementation Actions The American Dental Association strives to make this report as comprehensive and timely as possible; however, it is based upon a compilation of third party sources and selfreported information.. 1 FPL Federal Poverty Level for 2004: $9,310 for family of 1 ($11,630-AK & $10,700-HI); $15,670 family of 3 ($19,590-AK & $18,020-HI); $18,850 family of 4 ($23,570-AK & 21,680-HI) HHS Web site in consultation with state Web site. State Approval Date Alabama 1/30/98 Alaska 12/11/98 Arizona 9/18/98 Arkansas ARKids First 8/6/98 Type of Program Income/ Eligibility 1 Cost Sharing/ Premium Dental Benefits Note Children to 19 years of age in families with income up to 200% of the FPL 175% FPL for children up to age 19 Ppl > 150% FPL pay $50/ child/yr (max $150/fam); Cp-pay $5- prevetive services excluded All major, preventive, diagnostic, and treatment dental Orthodontic services only when congenital malformation of the teeth and jaws interferes w/normal functioning. Preventive dental care, treatment of cavities, pain and infection, and the cost of dentures and orthodontia in extreme cases of malformation, if prior authorized. 200% FPL for children Prems. $10-35 Dental Service up to age 19 2 Package Prog A: 133% FPL for children <6, 6 thru 19 covered whose family makes up to 100% $10 co-pay per visit under program B Dental Care (orthodontia included) under program A 2 visits per year for $1,000 annual maximum benefit FPL eligibility reduced to 175% from 200%, effective September 2003 KidsCare dental is managed just like, all reimbursement, benefits & health plans) are same as the program. Program B is slightly more restrictive in some cases and is offered to those making too much to 1 FPL Federal Poverty Level

2 California 3/24/98 Colorado Children s Basic Health Plan (CHP+) 2/18/98 Connecticut Health Care for Uninsured Kids (HUSKY) 4/27/98 District of Columbia 9/17/98 Delaware 9/1/98 FPL. Prog B covers 0-19 up to 200% FPL Combination 250% FPL for children up to age % FPL through age 19. Combination Husky B covers 0-18 yr olds up to 300% FPL. Provides buy-in opp'ty for families over 300% FLP 2 200% FPL for children up to age % FPL for children up to age 19. Premiums range from $4-27 per month. Co-pays are $5, not to exceed $250 for non-preventive. Premiums set on a sliding fee scale. $5 co-pay for restorations and extractions No co-pay for dental. 2 Copays and prems based on income; range from $650 max(185%- 235%) to $1,250 max (235%- 300%). Copay $5 per service for prostho, endo and oral surgery, extract & ortho. $10-25 monthly premium. cleaning, full X-rays, and restorative services under program B. 2 Includes exams, cleanings, fillings, sealants, fluoride and X- rays as needed or determined medically necessary. Covers exams, cleanings, X-rays, fillings, routine extractions, limited root canal therapy, other diagnostic and preventive Maximum allowable benefit $500. coverage includes EPSDT State plan includes basic dental services: exams, x-rays, fillings, fluoride, oral surgery and sealants. Orthodontia allowed with co-pay. services Benefits are equal to the state employees plan. qualify for Program A. Purchasing credit is available to enable purchase of employersponsored coverage. Included certain parents until 1/03-funding constraints Governor appointed a Commission to guide/ implement SCHIP dental program. Delta Dental chosen as carrier. coverage is based on state employee health benefits.. Dental added 2006

3 Florida MediKids; HealthyKids 3/5/97 Georgia Peach Care 9/3/98 Combination Age 0-1, % FPL. Age 1-4, % FPL. Age 5-19, % FPL. Age 0-1, % FPL. Age 1-6, % FPL. Age 6-19, % FPL. $20 per month. $5 co-pay for non- preventive srvcs. For children over age 6, monthly premium of 10- $35 for 1, 15- $70 for 2+ children. Full diagnostic and preventive services, basic and restorative care, as well as major restorative treatment. Healthy Kids covers 55 out of 67 counties with preventive dental benefits 2 Provides essentially the same scope of medical and dental services as are available in the program Healthy Kids cited in SCHIP statute as 1 of 3 grandfathered programs. In 2004, $750 annual dental cap, $12 per member per month maximum benefit expenditure instituted (reduced from $17); may reduce the level of dental benefits.

4 State Approval Date Hawaii 1/19/99 Idaho 6/15/98 Illinois Kid Care 4/1/98 Indiana 6/26/98 Iowa HAWK-I 9/1/98 Kansas Health Wave 9/1/98 Type of Program Income/ Eligibility 2 Cost Sharing/ Premium Dental Benefits Note Children in families with income between services 100% and 200% of the FPL who exceed eligibility requirements Up to 150% FPL for children up to age 19. Combination 5 parts to program. 133% FPL (Assist & Moms and Babies); % FPL (Share); % FPL (Premium); and % FPL (Rebate.) Combination 150% FPL for children to age 18 (); 200% FPL (non- ) for children to age 19. Combination % FPL for children up to age 19 () Hawk-I (non-) % FPL through age % FPL for children up to age 19 who exceed eligibility for. Modest co-pay for Kid Care Share; premiums and co-pays for Kid Care Premium15- $30. Sliding scale copays for those in non- program. $11- $24.75 $10-20 premium per month. For families >150% FPL income. $20-$30 per month, depending upon family income. services Based on benefits of participating health plan. Part of cost of insurance is reimbursed under the Kid Care Rebate program. coverage is equivalent to that provided by the BC/BS PPO option for federal employees. 2 FPL Federal Poverty Level

5 Kentucky K-CHIP 11/25/98 Louisiana LaCHIP 10/20/98 Maine CubCare 8/7/98 Maryland Maryland Children s Health Program (MCHP) & MCHP Premium Combination 185% FPL for children age 0-1; 150% FPL 1-18; as determined eligible by the state (); 200% FPL (non- [K-CHIP]) for children thru age % FPL for children up to age , who meet state eligibility requirements Combination ( Expansion) 0-1 up to 185% FPL; 1-18 up to 150%; who meet state eligibility requirements. CubCare (Non ) % Combination Up to 200% FPL for children up to age 18 (); % FPL (non-) Premiums of $20/fam/month for families with income of % FPL under KCHIP. Copay of $2 per non-preventive dental visit. Sliding scale premiums for those over 151% FPL 5- $40. Enrollees pay a monthly premium per family Non- /separate program has a few limitations on dental services. The screening portion of Louisiana s EPSDT service is known as KIDMED Coverage provided either thru HealthChoice managed care program that does health care for and MCHPeligible children, or thru qualifying employersponsored insurance

6 State Approval Date Massachusetts 5/29/98 MassHealth Standard, Family Assistance, Premium Assistance Michigan MIChild 4/7/97 Minnesota Minnesota Care 7/17/98 Type of Program Income/ Eligibility 3 Cost Sharing/ Premium Dental Benefits Note Combination 0-1 up to 200% FPL, Sliding scale 1-18 up to 150% FPL. premiums for 19 to 21 who meet those in state state eligibility program and requirements employer (). Age 0- sponsored 19, % FPL coverage. (non-medicaid) Combination % FPL, 19 to 21 who meet state eligibility requirements (); 200% FPL (non-) for children ages Preg women & children under age 2 at or below 280% FPL. ages 2-18 with income to 170% FPL. 19 to 21 who meet state eligibility requirements No copay, but $5 premium/mo in families with income between 151% and 200% FPL. No co-pay. Over 150% FPL premium of $48/child/yr. Preg. women and children having family income above 275% of the FPL pay sliding scale premium EPSDT services for program. Exams, x-rays, Prophys, restorations, sealants, emergency visits, stainless steel crowns, pulpotomies, space maintainers and simple extractions. State program benefits based on coverage for state employees. Maximum annual benefit is $600. Comment [o1]: huh?? 3 FPL Federal Poverty Level

7 Mississippi 10/26/98 Missouri 4/28/98 Montana 9/11/98 Nebraska Kids Connection 8/7/98 Combination 0-1 up to 185% FPL, 1-6 up to 133% FPL, 6-18 at or below 100% FPL. Ages 19 to 21 who meet the state s eligibility requirements (). Up to 200% FPK (non- ) 300% FPL for children up to age 18. There are no copayments for dental visits % pay premiums of $62-$252. Copay $5-$10 copay required but not when the visit is for prevention services only. 150% FPL. Copayments for dental services are not required. 185% FPL for children up to age 19 & those ages 19 up to 21 who meet the state s eligibility requirements. Effective January 2002, expanded to cover additional restorative, endo,& perio services and space maintainers. Adults in the MC+ region will receive benefits equal to the state employees plan. All CDT-4, except: Maxillofacial Prosthetics, Implant Services, Treatment of Fractures, Other Repair Procedures, and Orthodontic Services. The CHIP dental benefit is limited to a maximum of $1,500 per patient per year. Dental benefits include orthodontics to age 21. Maximum benefit $350, per child per year.

8 Nevada Check Up 8/13/98 New Hampshire Healthy Kids 9/15/98 200% FPL The premium is determined by family size and income & ranges from $60/yr- $280. No Copay Combination % FPL; 1-18 up to 185% (-Healthy Kids Gold). Healthy Kids Silver (non-) covers 1-19 with income between 185% and 300% of the FPL. 185%-250% FPL Silver I 250%-300% FPL Silver II; 300%-400% FPL Silver Buy-in $25-$45 Silver Plans. No copay. Dental coverage includes preventive, diagnostic, treatment, and other EPSDT dental provided thru Gold. Healthy Kids Silver includes 2 dental exams and cleanings per year, 1 fluoride treatment; radiographs, dental sealants, routine restorations, and emergency care. There is an annual maximum benefit of $600 per child. Placement of more than seven stainless steel crowns in one visit and medically necessary orthodontic services require prior authorization. The Gold Plan takes a managed care approach.

9 State Approval Date New Jersey Family Care (A,B,C,&D) 4/27/98 New Mexico SALUD! 3/1/99 New York Child Health Plus B 4/1/98 Type of Program Income/ Eligibility 4 Cost Sharing/ Premium Dental Benefits Note Combination Age 0-1 with income to Premiums range Comprehensive in 185 FPL, and ages 1- from $17- plans A, B & C. Plan 19 with income thru $113/mon. Plan D preventive thru age 133% FPL (). C $5 copay for 12 only. (Non-) non-preventive. Program B ages 1-19 with income 134 to150% FPL; C ages 1-19 with income 151 to 200% FPL & 0-1 in families with 186 to 200% FPL; D 0-19 with income 200 to 350% FPL, achieved via use of income disregards $5 copay for nonpreventive dental for families with incomes 186% to 235% FPL Ages 1 month to19 with income up to 250% FPL (or net equivalent of 208% after 20% income disregard). No premiums and small copayment Cost sharing ranges from $9-45 per month. Equal to EPSDT Benefits are provided by HMOs participating in New Jersey Care managed health program. Three MCOs subcontract delivery of dental services to Doral,which, reimburses dental providers on a feefor-service basis. Benefits exclude orthodontia. This is one of three plans grandfathered by HCFA. 4 FPL Federal Poverty Level

10 North Carolina 7/14/98 North Dakota Healthy Steps 10/9/98 Ohio 3/23/98 200% FPL for children up to age 18. Up to 225% may buy-in. Combination 0-6 up to 133% FPL; 6-19 at or below 100% FPL () Up to 140% FPL for children up to age 18 (non- -Healthy Steps)). 200% FPL for children up to age 19. $5 co-pays for non-preventive dental. $50- $100 enrollment fee. $25 per child, with a maximum of $75 per family (suspended indefinitely). No copay for dental Dental services include comprehensive array of dental benefits, including fluoride, sealants, extractions, routine restorations, therapeutic pulpotomies, and prefabricated stainless steel crowns; no ortho and advanced perio. services (). Healthy Steps includes exams, X-rays, prophys, fluoride, sealants, emergency care, restorative services, crowns, and TMJ (with lifetime limits). Space maintainers included, but no other orthodontic Healthy Steps (non- ) is modeled on the state employees insurance plan. The only mandatory managed care (MCO) programs are in four counties (Cuyahoga, Lucas, Stark, and Summit).

11 Oklahoma Sooner Care 5/26/98 Oregon Children s Health Insurance Program 6/12/98 Pennsylvania PA CHIP 5/28/98 185% FPL for children up to age 18 Ages % FPL up to 185%. 200% FPL for children up to age 18 The Health Services Commission prioritizes 745 primary and acute medical and mental illness Legislature authorizes funding for items 1 to 606, creating Benefit Package cover most current mandates. Exams and fluoride (1 per 180 days), X-rays, X-rays, prophys, & restorative, including, crowns, resins, extractions, sealants, amalgams, endo, and space maintainers. As of 1/04, HMO system terminated (and Doral Dental, the administrator of the dental program for the MCOs), members transitioned into statewide SoonerCare Choice, Enrollees of PCCM receive dental care participating dentists reimbursed via fee-forservice. The comprehensive benefit package also includes casemanagement, preventive health care, interpreter, and non-emergency transportation Rhode Island RIte Care 5/8/98 250% FPL through age 18 Premiums of $61, $77, $92/mo. RIte Care dental beneficiaries are considered out-of-plan benefits & administered directly by RI.

12 State Approval Date South Carolina Partners for Healthy Children 2/19/98 South Dakota 8/25/98 Tennessee Tenn Care 9/3/99 Texas 6/15/98 Utah 7/10/98 Type of Program Income/ Eligibility 5 Cost Sharing/ Premium Dental Benefits Note 150% FPL for children up to age 19 () Combination 200% FPL for children ages % FPL for under age 19 Children with incomes over limits but below 200% FPL. CHIP A children with income to 150% FPL. CHIP B children with income to 200% FPL. Beneficiaries ages pay $3.00 for the cost of their care on each date of service. Cost sharing required at certain income levels. CHIP A require a $3.00 copay. Quarterly prems $13 per family. CHIP B same dental benefit as CHIP A, but coinsurance 20% of allowed charges for nonpreventive/diagnostic Quarterly premium $25. State program modeled on state employee benefits. 2 dental exams / year, selected x-rays and cleanings, sealants & topical fluoride, fillings and stainless steel crowns, space maintainers, extractions, and pulpotomy/pulpal therapy. HMO optional; dental care delivered via feefor-service. Children do not need to be referred by primary care providers to receive oral health care. September 2003, dental benefits for CHIP enrollees were discontinued Effective in 2002, dental benefits under CHIP were reduced to preventive and emergency services only. Restored July FPL Federal Poverty Level

13 Vermont Dr. Dynasaur 12/15/98 Virginia Family Access to Medical Insurance Security (FAMIS) 10/22/98 Washington 9/8/ % FPL up to age % FPL for children up to age % FPL for children up to age 18. Underinsured pay $35/mo premium, Uninsured pay $70/mo. In June 2004, no child under 18 years of age has copay requirements For MCO plans, copay are as follows: routine, complex restorative, and prosthetic services have $2 copay for children with income <150% of the FPL. $5 copay required for children with income >150% FPL. Premium $15/child/mo, up to a $45 monthly max, regardless of family income Same as EPSDT benefits. Comprehensive dental benefits including orthodontia Same as EPSDT benefits In 1989 (almost a decade before CHIP), Vermont created a state-funded health care program for uninsured children through age six who were from families with incomes up to 225% of FPL and did not qualify for traditional (Dr. Dynasaur) Some services may require preauthorization. Based on beneficiary s geographic location, medical benefits either will be similar to, or enhanced benefit package based on the state employee health plan. This plan is delivered only through contracted MCOs and copays are required. Dental provided as a carve out of managed care.

14 West Virginia WV CHIP 9/15/98 Wisconsin Badger Care 5/29/98 Wyoming Kid Care CHIP 9/8/99 Up to 200% FPL for uninsured children younger than age 19 who are not eligible for Initial FPL requirement is 185%. Child remains eligible until income exceeds 200% FPL 185% FPL for children up to age 19. Families with incomes >150% FPL pay premium 5% of family income Exams every 6 mos; full-mouth x-ray every 36 mos, sealants and fillings as needed; simple extractions; treatment of abscesses, including initial visit and follow-up if needed; extraction related to abscess; root canal therapy; and removal of cysts under tooth or gums and x-rays needed to diagnose. Same as EPSDT benefits Same as EPSDT benefits In 2001, an action plan developed by the WVDA and other stakeholders was developed with the basic goals of raising awareness about the importance of oral health; increasing the demand for oral health services; and improving the supply of oral health A Section 1115 waiver will allow parents and other children to enroll, in families with incomes up to 200% FPL Services have a per child/per benefit year maximum expenditure limit of $750. American Dental Association, Department of State Government Affairs December 12, 2004