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Model Application Template for the State Children’s Health Insurance Program

Effective Date:

October 1, 2009 22 Approval Date: November 19, 2010

4.3. Describe the methods of establishing eligibility and continuing enrollment. (Section 2102)(b)(2)) (42CFR 457.350) Applying the ALL Kids Eligibility Standards The eligibility standards for initial enrollment are as follows:

Under 19 years of age From just above the upper Medicaid income eligibility level (133% of FPL for children under 6 years old and 100% of FPL for children aged 6-18) to and including 300% FPL

Not be enrolled in or eligible for Medicaid Not covered by another group health insurance policy or have had coverage voluntarily terminated within the last 90 days (exceptions to this can be found in Sections 4.1.7 and in 4.4.4.3)

Not eligible for state health benefits coverage under a state health benefits plan

Not in an institution

Resident of Alabama Citizen of the US or an eligible “immigrant” child (The definition of an eligible immigrant child is the definition described in the January 14, 1998 “Dear State Health Official” letter from HCFA and HRSA. This letter indicates that any child born in the United States is a citizen and eligible to receive services funded by CHIP in addition to: • All legal immigrant children who were in the US before August 22, 1996, • Refugees, asylees and certain Cuban, Haitian and Amerasian immigrants, • Unmarried, dependent children of veterans and active duty service members of the Armed Forces, and • Legal immigrants arriving on or after August 22, 1996, and in continuous residence for 5 years. Applying the ALL Kids PLUS Eligibility Standards The eligibility standards for initial enrollment are as follows:

Be enrolled in the basic ALL Kids Program

Have a condition for which a PLUS service is available Be in need of a PLUS agency authorized ALL Kids PLUS service for which the participating agency has funds available

Redetermination Process Redetermination (renewal) is completed every 12 months. For renewal, all of the preceding standards apply and in addition, the family must be current with any outstanding premium balances. In order to facilitate continuous coverage, notices of any premium balances owed are sent to the family periodically throughout the year including a premium notice sent with the renewal form. A “coming soon” postcard is sent to the family ten weeks prior to the renewal date. The preprinted renewal form is sent to the family eight weeks prior to renewal, and a second postcard is sent as a reminder notice at six weeks prior to the renewal date. Once the renewal form is received, it is processed in exactly the same way as a new application is processed, including a check on Medicaid status and insurance coverage with Blue Cross Blue