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

ARKANSAS Effective Date: July 1, 2003

Approval Date: 18 4.4.4 The insurance provided under the state child health plan does not substitute for coverage under group health plans. Check the appropriate box. (Section 2102)(b)(3)(C)) (42CFR 457.805) (42 CFR 457.810(a)-(c))

4.4.4.1. Coverage provided to children in families at or below 200% FPL: describe the methods of monitoring substitution.

Coverage for the unborn child covers only those who do not qualify for Medicaid although the income and resource limit is the same as the SOBRA pregnant women’s Medicaid category; the difference is that the unborn child coverage does not require the pregnant woman to meet Medicaid citizenship requirements. The state child health program requires that the pregnant woman has no health insurance coverage for the pregnancy. Also, the unborn child benefit package is limited to services related to the pregnancy, or which if not treated could complicate the pregnancy; and the eligibility period is limited. Due to the above factors, the State does not think there will be substitution of coverage.

4.4.4.2. Coverage provided to children in families over 200% and up to 250% FPL: describe how substitution is monitored and identify specific strategies to limit substitution if levels become unacceptable.

4.4.4.3. Coverage provided to children in families above 250% FPL: describe how substitution is monitored and identify specific strategies in place to prevent substitution.

4.4.4.4. If the state provides coverage under a premium assistance program, describe:

The minimum period without coverage under a group health plan, including any allowable exceptions to the waiting period.

The minimum employer contribution.

The cost-effectiveness determination.