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:

*  

inpatient and outpatient hospital services,

*  

physicians' surgical and medical services,

*  

laboratory and X-ray services, and

*  

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:

*  

prescription medications,

*  

mental health services,

*  

vision services, and

*  

hearing services.

The following are optional services:

*  

clinic services;

*  

over-the-counter medications;

*  

prenatal care and family planning supplies;

*  

inpatient mental health services;

*  

durable medical equipment and other medical devices;

*  

disposable medical supplies;

*  

home- and community-based services;

*  

nursing-care services;

*  

dental services;

*  

inpatient and outpatient substance abuse treatment and services;

*  

case management services;

*  

care coordination;

*  

physical, occupational, and speech therapy;

*  

hospice care;

*  

medical transportation;

*  

enabling services (e.g., transportation and translation services); and

*  

any other services specified by DHHS or recognized by state law and prescribed by a licensed physician or practitioner.

SOURCE: Johnson and McDonough, 1998.



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