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• Parents or children of individuals with special immigrant status under section 101(a)(27) of the INA as permitted under section 101(a)(15)(N) of the INA; • Fiancées of a citizen as permitted under section 101(a)(15)(K) of the INA; • Religious workers under section 101(a)(15)(R); • Individuals assisting the Department of Justice in a criminal investigation as permitted under section 101(a)(15)(U) of the INA; • Battered aliens; and • Individuals with a petition pending for 3 years or more as permitted under section 101(a)(15)(V) of the INA. Lawfully Residing children enrolled in the Healthy Families Program (HFP) are required to provide valid documentation. While enrolled in the HFP, these Lawfully Residing children are eligible for funding under Title XXI, however will be subjected to re-verification of documentation at the Annual Eligibility Review (AER) process, to the extent necessary to ensure continued valid status. X _____The State elects the CHIPRA section 214 option for children up to age 19 _____ The State elects the CHIPRA section 214 option for pregnant women through the 60-day postpartum period 4.1.10.1___X__ The State provides assurance that for individuals whom it enrolls in CHIP under the CHIPRA section 214 option that it has verified, both at the time of the individual’s initial eligibility determination and at the time of the eligibility redetermination, that the individual continues to be lawfully residing in the United States. The State must first attempt to verify this status using information provided at the time of initial application. If the State cannot do so from the information readily available, it must require the individual to provide documentation or further evidence to verify satisfactory immigration status in the same manner as it would for anyone else claiming satisfactory immigration status under section 1137(d) of the Act. Under the Children’s Health Insurance Program Reauthorization Act (CHIPRA) of 2009, eligible qualified Lawfully Residing children will be funded under Title XXI. If the documentation has expired, during their twelve (12) full months of HFP enrollment, they will be subjected to re-verification of documentation at the Annual Eligibility Review (AER) process, to ensure their status remains valid and they are still eligible for funding under Title XXI. If the documentation has Effective Date: Approval Date: November 1, 2009 HFP Family Contribution Increase November 1, 2009 HFP Co-Payment Increase November 1, 2009 HFP Limited Dental Plan Choice for New Subscribers

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