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DELAWARE HEALTHY CHILDREN PROGRAM (DHCP) 12

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

The application form for Delaware’s Title XXI program will be incorporated into the Medicaid application so that there is no need to apply separately after a determination of Medicaid eligibility is completed.

Eligibility will always be determined, as defined in the remainder of this section, by staff under the administration of the Title XIX/Medicaid program, using abbreviated, mail-in applications and outstationing eligibility staff at various sites. On a daily basis, the information on all Title XIX and Title XXI clients will be electronically transferred to the State’s Health Benefits Manager and the State’s Fiscal Agent. The Health Benefits Manager will mail information regarding all available MCO choices to the client. As with Title XIX, clients eligible under Title XXI will have an enrollment application that pre-selects an MCO for them. If written or verbal contact is not made by the client to the HBM within thirty (30) days of their eligibility start date, they will be assigned to the pre-assigned MCO. The HBM does a follow-up telephone contact 20 days after the first notice. All information from the HBM to the Title XXI eligible will carry the name of the Title XXI program and will be separate and distinct from Title XIX information.

Applicants who have been uninsured less than 6 months will be given a time when their pending application for the program can be approved. Families who do not pay the premiums may re-enroll at any time without penalty, with the re-enrollment period starting with the first month for which the premium is paid.

4.3.1 Describe the state’s policies governing enrollment caps and waiting lists (if any) (Section 2106(b)(7)) (42CFR 457.305(b))

Check here if this section does not apply to your state.

4.4 Describe the procedures that assure that:

4.4.1 Through the screening procedures used at intake and follow-up eligibility determination, including any periodic redetermination, that only targeted low- income children who are ineligible for Medicaid or not covered under a group health plan or health insurance coverage (including a state health benefits plan) are furnished child health assistance under the state child health plan; (Section 2102(b)(3)(A)) (42 CFR 457.350(a)(1) and 457.80(c)(3)

The Delaware Client Information System (DCIS) and the Medicaid Management Information System (MMIS) will be used to monitor and control eligibility. The DCIS will contain edits that assure that income and age limitations are not exceeded and that action is taken when a child is about to turn age 19. Likewise, the MMIS will contain edits that