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

Effective Date:

Approval Date: 16

2.3. Describe the procedures the state uses to accomplish coordination of SCHIP with other public and private health insurance programs, sources of health benefits coverage for children, and relevant child health programs, such as title V, that provide health care services for low-income children to increase the number of children with creditable health coverage. (Previously 4.4.5.) (Section 2102)(a)(3) and 2102(c)(2) and 2102(b)(3)(E)) (42CFR 457.80(c))

At the time a child is determined not to be eligible for hawk-i, the letter the applicant receives states: "Although you child does not qualify for hawk-i, health care services may be available through your local child health agency. For information about the child health center in your area, please call 1-800- 369-2229 (Iowa Healthy Families Information and Referral Service)."

When it is determined that a child does not qualify or will no longer qualify for Medicaid due to excess income, a referral is made to hawk-i. The referral can be accomplished either electronically or using a paper form. In either format, the referral includes the name of the child (or children), the Medicaid application date (for children denied Medicaid) or the Medicaid end date (for children cancelled from Medicaid), and the reason for the referral. The electronic referral also includes the income amounts used to determine Medicaid ineligibility. A copy of the Medicaid notice of decision denying or cancelling Medicaid accompanies the paper referral. This notice contains a calculation showing how Medicaid ineligibility due to excess income was determined.

The third party administrator performs a comparison of hawk-i enrollees to Medicaid enrollees. A file containing the Medicaid enrollees is received and matched daily with the hawk-i enrollee file. If a match is found, the child is cancelled from hawk-i after being given notice of the cancellation.

If an individual applying for health services through a public health clinic also wishes to apply for Medicaid or hawk-i, the public health clinic will forward this information to hawk-i within two working days.

If an individual applying for WIC services also wishes to apply for Medicaid, the WIC agency will forward the information to Medicaid. If an individual applying for WIC appears to qualify for hawk-i, the individual is given a hawk-i enrollment form.

If a child applying for hawk-i is determined to be eligible for Medicaid, a referral for EPSDT is made. If a child or family asks about WIC, a WIC brochure along with the location of the nearest WIC is given to them.