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

Effective Date:

October 1, 2009 51 Approval Date: November 19, 2010 Implementation of plans to target outreach to Hispanics Native Americans, and birth-to-five providers Documentation of implementation of these plans on file Development and implementation of plans to target outreach to other groups Documentation of development and implementation of these plans on file Elimination of language and culture barriers Spanish and English brochures and applications forms on file Employment of bi-lingual customer service staff ALL Kids Customer service telephone operators are aware of and know how to use a telephone translating service. Reduction in percentage of children canceling ALL Kids due to nonparticipation in the renewal process Enrollment Data Management system – Comparison of number of enrollees who did not participate in the renewal process to those due to renew. Related to increasing Medicaid Enrollment Maintenance of effort with regard to: Use of a joint application form A joint SOBRA Medicaid and ALL Kids application form is in use Use of a joint renewal form A joint SOBRA Medicaid and ALL Kids renewal form is in use