Provider Medicaid and CHIP Benefit Summaries


Please choose a link below to open charts, which describe the specific benefits and co-pays for the Medicaid and the CHIP programs.

Please be aware that the State Medicaid cards are color coded specific to the Medicaid plan type. There are 3 plan types. Molina Healthcare manages "Traditional Medicaid" (purple card) and "Non-Traditional Medicaid" (blue card). The State manages the PCN (yellow card).


Benefit Summaries

icon pdf CHIP Medical and Dental Co-Payment Schedule

icon pdf Medicaid Benefits-At-A-Glance




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