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

Effective Date:

October 1, 2009 52 Approval Date: November 19, 2010 Seamless referral between ALL Kids and SOBRA Medicaid Seamless referral policy in place Continued outreach effort Outreach/Marketing files reflect outreach conducted by central office staff, regional staff, and federal program office. Evaluation of application transfer and referral process Evaluation on files of meeting minutes Continued computer enhancements Computer enhancements will be in place. Related to increasing access to care Reported usual source of care New Enrollees Survey Reported ER use New Enrollees Survey Related to use of preventive care

Reported use of well-child check-up New Enrollees Survey Reported dental visit New Enrollees Survey Reported vision screening New Enrollees Survey Other

Specialty service availability Contract(s) on file Exploration of feasibility for establishing contracts with other CSHCN state agencies Documentation on file (central office files and/or regional coordinator files) Monitoring access to care for CSHCN New Enrollees Survey