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

Effective Date:

October 1, 2009 63 Approval Date: November 19, 2010 3. Customer Service – staff respond to telephone inquiries about potential applicants, questions about eligibility, and general questions about benefits.

The following describes current procedures used to evaluate eligibility for ALL Kids:

Applications in self-addressed, stamped envelopes, for ALL Kids coverage are received through the postal service into a centralized enrollment unit. Applications are widely available from a variety of places in the community including county health departments, doctor’s offices and pharmacies, through the toll free number or by downloading from the Department’s website.

In the current ADPH system, employees enter all information found on the application into an internal Application Tracking and Eligibility Determination System. Applicants are groups by family unit and assigned a unique person identifier (this is different from SSN - we require SSN for applicants, but not parents). Family size and income are calculated by the automated system and Health Insurance Assistants ensure that these calculations are correct and approve the child for enrollment or refer them to the appropriate partner agency. If the child is ALL Kids eligible, the system transmits data of all approved applications to Blue Cross Blue Shield of Alabama for verification and enrollment in the health plan. Prior to enrollment, BCBS verifies that the applicant is not already enrolled in any other BCBS health insurance plan and therefore ineligible for ALL Kids coverage. Approximately 85% of the insured lives in Alabama have health insurance through BCBS. Therefore, this final check on eligibility is an efficient way to monitor and prevent crowd-out.

The Medicaid Electronic Data system is also accessed prior to award of coverage in order to determine if the applicant is currently enrolled in Medicaid. If this inquiry reveals that a child is currently on Medicaid the family is be notified that their child(ren) are not eligible for ALL Kids.

Notification is made to the applicant after eligibility is determined and those determined ineligible are referred to the appropriate health insurance program. Applications which appear to be eligible for Medicaid or ACCF are mailed at least weekly to these programs.

ALL Kids provides twelve months of continuous coverage for all enrolled children. At the end of this twelve-month period, participants must complete an annual renewal in order to remain enrolled in the program.

As of September 30, 2002 there were 52,495 participants in the ALL Kids program.