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

Effective Date:

Approval Date: 28

considered uninsured for the purpose of establishing hawk-i eligibility. Effective July 1, 2003, the State no longer imposes a 6- month waiting period for children who have been insured through an employer group health plan in the six months prior to the month of application. Iowa House File 565 included provisions that require the Department to monitor the effects of eliminating the 6-month waiting period and report back to the General Assembly on the findings. The state is continuing to ask insurance history questions on the application form and the information is being tracked by the state's third party administrator. A quarterly report will identify the impact of this change on the program and be reported to the General Assembly.

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. See response to 4.4.4.3

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.

A match with insurance carriers is done at application to determine if the child has other health insurance. The report indicates if there is other health coverage, the effective date of the coverage and the date the coverage ended if applicable. To be eligible, a child whose family‟s income is from 251 to 300% FPL, must not have dropped health insurance coverage in the month prior to the month in which the child would otherwise be eligible. If health insurance was dropped, the effective date of the hawk-i coverage will be delayed by one (1) month. Children who have lost health insurance coverage due to one of the following reasons will not be subject to the one (1) month waiting period. 1. The child is moving from Medicaid to hawk-i. 2. The child has a chronic or emergent medical condition. 3. The cost of the health care coverage for the child