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

Effective Date:

October 1, 2009 50 Approval Date: November 19, 2010 Measure of Performance: MEASURE ROUGH DEFINITION OF MEASURE

Reducing the Number of Uninsured Number of Uninsured CPS and/or NSAF and state data survey Tracking System Documentation that a tracking system exists and is used for 100% of the applications that are referred among ALL Kids, Medicaid, and Alabama Child Caring Foundation Related to SCHIP Enrollment Percentage of families not renewing due to owing past premiums Renewal database – comparison of number of non- renewals who owed premiums to the number who were due to renew. Percentage of families reporting a reduction in financial barriers to accessing health care New enrollee survey database – comparison of percentage of reports indicating a reduction in financial barriers to obtaining health care post-ALL Kids to pre-ALL Kids Development of plans to target outreach to adolescents, faith-based organizations Documentation of development of these plans on file Implementation of plans to target outreach to adolescents, faith-based organizations Documentation of implementation of these plans on file Development of plans to target outreach to Hispanics, Native Americans, and birth-to-five providers Documentation of development of these plans on file