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

Effective Date:

October 1, 2009 62 Approval Date: November 19, 2010 ATTACHMENT C

ENROLLMENT UNIT

There have been two phases of the CHIP Program:

Phase 1: Medicaid Expansion – CHIP dollars were used to expand Medicaid services to children ages 14 through 18. CHIP money was used for this from February 1998 through the end of fiscal year 2002. The State Medicaid Agency determines the eligibility for this component using outstationed eligibility staff who are located throughout the state. While not responsible for the day-to-day administration of this portion of the CHIP program, ADPH works closely with Medicaid to ensure continued success.

Phase 2: ALL Kids – This part of the CHIP program provides insurance coverage to individuals meeting the following criteria:

a) Legal residents of the State of Alabama b) Under 19 years of age c) Family income above Medicaid income limits up to and including 200 % of the Federal Poverty Level (FPL). d) Not eligible for Medicaid e) Not covered under private group health insurance f) Not eligible for a state or public employee insurance coverage g) Not currently in a public institution h) U. S. citizen or eligible immigrant

From the beginning of the program in October 1998 until June 2001, the Alabama Department of Public Health (ADPH) contracted with the State Employees’ Insurance Board (SEIB) to determine eligibility for the ALL Kids portion of CHIP. In March 2001, through mutual agreement, the decision was made to transfer the staff and this function to the ADPH. This was accomplished in two phases. In June 2001 the transfer of personnel and eligibility determination functions took place and in September 2001 all remaining electronic transaction responsibilities and accounting responsibilities were transferred.

The enrollment unit is divided into three (3) functional sections: 1. Distribution – staff receive, open mail, and enter general applicant information into the enrollment database. 2. Application/Renewal Processing – staff review applications, enter remaining information, (check to see if premiums have been paid for renewals), verify applicant is not already enrolled in Medicaid, screen for Medicaid eligibility, and approve enrollment into ALL Kids as appropriate. If information is missing or needs clarification, staff will contact applicant by phone or in writing to obtain or clarify information. Appropriate letters are prepared informing applicant of enrollment or referral of the application.