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

Effective Date:

October 1, 2009 48 Approval Date: November 19, 2010 d. Plans which target outreach activities toward specific populations: (adolescents, Native Americans, and faith-based organizations) will be implemented each year beginning with FY 2003. e. Plans which target outreach activities toward Hispanics, birth-to-five care providers, and Native Americans will be developed by January 1, 2004. f. Plans which target outreach activities toward Hispanics, birth-to-five care providers, and Native Americans will be implemented each year beginning with FY 2005. g. Plans which target outreach activities toward specific populations (other than adolescents, faith-based organizations, Hispanics, birth-to-five care providers, and Native Americans) will be developed and implemented as data or other information indicate. h. Language and culture will not be barriers to enrollment or renewal as evidenced by the availability of telephone assistance in the customers’ preferred languages, brochures and forms in both English and Spanish, and the availability of Spanish speaking, culturally competent customer service staff. i. There will be an incremental reduction from year to year, in the percentage of children canceling ALL Kids coverage due to nonparticipation in the renewal process.

3. Performance Goal for Objective 3: There will be maintenance of effort or an increase, on the part of CHIP, to decrease the number of uninsured low-income (Medicaid eligible) children as evidenced by at least the following:

i. Continued use of a joint application form. ii. Continued use of a joint renewal form iii. Continued referral, without any barriers, of applications and renewals between ALL Kids and SOBRA Medicaid iv. Continued outreach efforts by CHIP staff for network building with community groups, professionals (individually and in groups), child care providers, schools, etc. v. Continued evaluation and monitoring of the application transfer/referral process between ALL Kids and Medicaid. vi. Continued computer enhancements to improve the communication with other agencies and current and potential ALL Kids enrollees.

4. Performance Goals for Objective 4: a. A higher percentage of families report that their ALL Kids enrolled child(ren) have a usual source of care since enrollment in ALL Kids than before enrollment in ALL Kids. b. A lower percentage of families report that their ALL Kids enrolled child(ren) have used a hospital emergency room since enrollment in ALL Kids than before enrollment in ALL Kids.