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DELAWARE HEALTHY CHILDREN PROGRAM (DHCP) 11

Transmittal # DHCP SPA #5 Approval Date July 28, 2009 Supersedes Transmittal # DHCP SPA #4 Effective Date April 1, 2009

4.1.5

Residency (so long as residency requirement is not based on length of time in state): Must be current Delaware resident with intent to remain.

4.1.6

Disability Status (so long as any standard relating to disability status does not restrict eligibility):

4.1.7

Access to or coverage under other health coverage: Must be uninsured for at least 6 previous months (see exceptions in section 4.4.4.1).

4.1.8 Duration of eligibility: 12 months of guaranteed eligibility

4.1.9

Other standards (identify and describe): must be (1) a citizen of the United States or must have legally resided in the US for at least 5 years if their date of entrance into the US is 8/22/96 or (2) meet the Personal Responsibility and Work Opportunity Reconciliation Act of 1997 (PRWORA) definition of qualified alien; and (3) ineligible for enrollment in any public group health plan; and, (4) a social security number is required for an applicant child, effective August 24, 2001.

4.2 The State assures that it has made the following findings with respect to the eligibility standards in its plan: (Section 2102(b) (1) (B)) (42 CFR 457.320(b))

4.2.1 These standards do not discriminate on the basis of diagnosis.

4.2.2 Within a defined group of covered targeted low-income children, these standards do not cover children of higher income families without covering children with a lower family income.

4.2.3 These standards do not deny eligibility based on a child having a pre- existing medical condition.

4.3 Describe the methods of establishing eligibility and continuing enrollment (Section 2102(b)(2)) (42 CFR 457.350)

Eligibility and redeterminations of eligibility will be conducted by staff under the administration of the Title XIX / Medicaid program consistent with those activities for Medicaid applicants / recipients.

Individuals will be enrolled with MCOs using the same Health Benefits Manager and the same process of enrollment as is used by Delaware’s Diamond State Health Plan. Individuals will be given a time frame to choose an MCO, and then, in the absence of any indication of choice, will be automatically assigned to an MCO based on location and availability of providers.