BOX 3.4 Services Allowed Under SCHIP
States can choose to expand Medicaid or offer one of the following: (1) one of three "benchmark" packages mentioned identified in the SCHIP legislation; (2) a package actuarially equivalent to one of the benchmark packages; (3) a comprehensive benefits package under an existing child health insurance program [available only to Florida, New York, and Pennsylvania.]; or (4) another benefit package approved by DHHS,
Actuarially equivalent packages must include four minimum benefits:
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inpatient and outpatient hospital services, |
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physicians' surgical and medical services, |
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laboratory and X-ray services, and |
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well-baby and well-child care that includes age-appropriate immunizations. |
| Equivalent coverage must have an actuarial value that is 75% of the costs of the following categories: |
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prescription medications, |
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mental health services, |
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vision services, and |
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hearing services. |
The following are optional services: |
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clinic services; |
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over-the-counter medications; |
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prenatal care and family planning supplies; |
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inpatient mental health services; |
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durable medical equipment and other medical devices; |
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disposable medical supplies; |
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home- and community-based services; |
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nursing-care services; |
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dental services; |
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inpatient and outpatient substance abuse treatment and services; |
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case management services; |
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care coordination; |
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physical, occupational, and speech therapy; |
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hospice care; |
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medical transportation; |
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enabling services (e.g., transportation and translation services); and |
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any other services specified by DHHS or recognized by state law and prescribed by a licensed physician or practitioner. |
| SOURCE: Johnson and McDonough, 1998. |