Non-emergency Use of the Emergency Department See more information in Prescription Drugs. States must specify which drugs are considered either "preferred" or "non-preferred." States also have the option to establish different copayments for mail order drugs and for drugs sold in a pharmacy. For people with income at or below 150% FPL, copayments are limited to nominal amounts. For people with incomes above 150% FPL, copayments for non-preferred drugs may be as high as 20 percent of the cost of the drug. To encourage the use of lower-cost drugs, states may establish different copayments for generic versus brand-name drugs or for drugs included on a preferred drug list. Medicaid rules give states the ability to use out of pocket charges to promote the most cost-effective use of prescription drugs. Certain groups, such as institutionalized individuals and most children, are excluded from higher cost sharing. States have the option to impose higher, alternative premiums on other groups of enrollees, if their family incomes exceed 150% of the federal poverty level. Disabled children eligible under the Family Opportunity Act (FOA).Disabled working individuals eligible under the Ticket to Work and Work Incentives Improvement Act of 1999 (TWWIIA).Qualified disabled and working individuals with income above 150% FPL ($16, 334 for an individual in 2011).Pregnant women and infants with family income at or above 150% FPL ($22,065 for a family of 2 in 2011).States can charge limited premiums and enrollment fees on the following groups of Medicaid enrollees: Certain vulnerable groups, such as children and pregnant women, are exempt from most out of pocket costs and copayments and coinsurance cannot be charged for certain services. Maximum out of pocket costs are limited, but states can impose higher charges for targeted groups of somewhat higher income people. Out of pocket costs may include copayments, coinsurance, deductibles, and other similar charges. States have the option to charge premiums and to establish out of pocket spending (cost sharing) requirements for Medicaid enrollees. Medicaid MAGI & CHIP Application Processing Time.Testing Experience & Functional Tools demonstration.Alternatives to Psychiatric Residential Treatment Facilities Demonstration.Balancing Long Term Services & Supports.Person-Centered Hospital Discharge Model.Vision and Hearing Screening Services for Children and Adolescents.Early and Periodic Screening, Diagnostic, and Treatment.State Planning Grants for Qualifying Community-Based Mobile Crisis Intervention Services.SUPPORT Act Provider Capacity Demonstration.SUPPORT Act Innovative State Initiatives and Strategies.Medicaid Information Technology Architecture.Section 223 Demonstration Program to Improve Community Mental Health Services.Actuarial Report on the Financial Outlook for Medicaid.CMS-64 FFCRA Increased FMAP Expenditure Data.State Budget & Expenditure Reporting for Medicaid and CHIP.Medicaid Eligibility Quality Control Program.Medicaid Third Party Liability & Coordination of Benefits.Seniors & Medicare and Medicaid Enrollees.Coronavirus Disease 2019 (COVID-19): Section 1115 Demonstrations.1115 Substance Use Disorder Demonstrations.1115 Demonstration Monitoring & Evaluation.Medicaid & CHIP Marketplace Interactions.Performance Indicator Technical Assistance.Medicaid Enrollment Data Collected Through MBES.April 2023 Medicaid & CHIP Enrollment Data Highlights.Home & Community Based Services Authorities.Lawfully Residing Immigrant Children & Pregnant Individuals.Medicaid and CHIP Quality Resource Library.Affordable Care Act Program Integrity Provisions.Medicaid and CHIP Eligibility & Enrollment Webinars.Unwinding and Returning to Regular Operations after COVID-19.Home & Community-Based Services in Public Health Emergencies.Using Section 1115 Demonstrations for Disaster Response.Medicaid Data Collection Tool (MDCT) Portal.Eligibility & Administration SPA Implementation Guides.Health Home Information Resource Center.Promoting Community Integration Through Long-Term Services and Supports.Improving Care for Medicaid Beneficiaries with Complex Care Needs and High Costs.
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