Center for Children and Families

Georgetown

Cost Sharing for Children and Families

Framing the Issue

Cost sharing is an established part of health insurance in this country, but it is imperative to use it judiciously in Medicaid and SCHIP to avoid deterring low-income children and families from using needed health care services. While some families served by these programs are able to pay premiums or make copayments, others, especially those at lower-income levels or with extensive health care needs, may find that such fees make it difficult for them to access needed care.

The research on cost sharing is clear that premiums and cost sharing charges will decrease enrollment and use of services among low-income families, but cannot definitively answer the question of “What is an appropriate premium level?” or “How much cost sharing is acceptable?” As a result, policymakers must carefully consider the tradeoffs and their competing policy goals when setting premium and cost sharing levels in Medicaid and SCHIP.

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Definitions

Table of Contents

Framing the Issue

Definitions

Legislative/Regulatory Authority

Where States Stand

Research

Strategies

Conclusion

Resources

Tables (PDF)

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