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

Effective Date:

October 1, 2009 26 Approval Date: November 19, 2010 at least weekly, directly to Medicaid Area supervisors for distribution to county Medicaid eligibility staff. Parents are notified by the ALL Kids enrollment unit regarding this referral and given information regarding expected timelines for Medicaid eligibility determination. Applications from families in 25 counties, on which all applicants appear to qualify for Medicaid, are given to the two Medicaid eligibility workers located within the CHIP eligibility unit.

CHIP and the Alabama Medicaid Agency central office are physically located two city blocks apart. If necessary, applications and renewals, forms can be easily transferred from one agency to the other (possibly on a daily basis) so that children can be enrolled in the appropriate insurance program on an expedited basis. Currently, applications not handled by Medicaid eligibility staff located in the ALL Kids enrollment unit, are mailed from the ALL Kids Office to the Medicaid Agency area supervisors for distribution to eligibility workers. Computer systems development is ongoing in order to facilitate electronic transfer of all referred applications.

4.4.3. The State is taking steps to assist in the enrollment in SCHIP of children determined ineligible for Medicaid. (Sections 2102(a)(1) and (2) and 2102(c)(2)) (42CFR 431.636(b)(4)) When a Medicaid enrollment worker determines that a child is ineligible for Medicaid due to income and potentially eligible for ALL Kids, the worker sends the application to the ALL Kids enrollment unit. No further eligibility determination is required. ALL Kids eligibility staff enter income and family size information as determined by the Medicaid eligibility worker and award coverage based on the application receipt date at the Medicaid office or the child’s last date of Medicaid coverage. ALL Kids staff work very closely with the Medicaid central office and Medicaid enrollment workers to ensure that the policies and procedures of both agencies reflect the agencies’ desires for a seamless referral system between the two.

4.4.4. The insurance provided under the state child health plan does not substitute for coverage under group health plans. Check the appropriate box. (Section 2102)(b)(3)(C)) (42CFR 457.805) (42 CFR 457.810(a)-(c))

4.4.4.1.  Coverage provided to children in families at or below 200% FPL: describe the methods of monitoring substitution.

4.4.4.2.  Coverage provided to children in families over 200% and up to 250% FPL: describe how substitution is monitored and identify specific strategies to limit substitution if levels become unacceptable.

4.4.4.3. X Coverage provided to children in families above 250% FPL: describe how substitution is monitored and identify specific strategies in place to prevent substitution.