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

Effective Date:

October 1, 2009 25 Approval Date: November 19, 2010 information on their family size, income, and other points of eligibility. Upon receipt of the form, ALL Kids enrollment staff will evaluate the child’s eligibility for ALL Kids. Then, either the child will be enrolled in ALL Kids or, based on the information on the form, the information will be sent to the Medicaid Agency or the Alabama Child Caring Foundation and the family will be notified that the child has been referred to another health insurance program.

Children who have current enrollment in ALL Kids will be allowed to continue to renew their enrollment as long as they continue to meet all points of eligibility and have their renewal forms and premium balances paid in full prior to the termination dates.

4.4. Describe the procedures that assure that:

4.4.1. Through the screening procedures used at intake and follow-up eligibility determination, including any periodic redetermination, that only targeted low-income children who are ineligible for Medicaid or not covered under a group health plan or health insurance coverage (including a state health benefits plan) are furnished child health assistance under the state child health plan. (Sections 2102(b)(3)(A) and 2110(b)(2)(B)) (42 CFR 457.310(b) (42CFR 457.350(a)(1)) 457.80(c)(3)) The State of Alabama assures that through enrollment screening processes, children whose applications are considered to be eligible for medical assistance under the State Medicaid plan will be referred for assistance under the appropriate plan. Additionally, ALL Kids eligibility staff query the Medicaid eligibility system to ensure applicants are not currently on any Medicaid program. All applications request the parent/guardian to provide the names and addresses of their employers. Eligibility staff screen all applications to ensure applicant children are not currently covered under group health insurance, have not voluntarily terminated group coverage within the last 90 days, and are not eligible for a state health benefits plan. If necessary, staff contact the State Employees’ Insurance Board for clarification of eligibility for a state health benefits plan. In an effort to further minimize crowd-out, the ALL Kids enrollment unit receives a daily “error report” which indicates children who have current BCBS health insurance or have terminated a BCBS policy within the last 90 days. In addition, quality assurance reviews are conducted on a sample of ALL Kids enrollees. Redetermination is completed every 12 months.

4.4.2. The Medicaid application and enrollment process is initiated and facilitated for children found through the screening to be potentially eligible for medical assistance under the state Medicaid plan under Title XIX. (Section 2102)(b)(3)(B)) (42CFR 457.350(a)(2)) When a child is screened by an ALL Kids enrollment worker as potentially eligible for Medicaid, the family’s application is sent to the Medicaid Agency. Because a joint application is used, no additional form is required to be completed. Medicaid eligibility staff have access to selected fields from the ALL Kids eligibility and enrollment data system in order to assist in processing applications referred from the ALL Kids enrollment unit. Applications are mailed,