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

Effective Date:

Approval Date: 64

Section 12. Applicant and Enrollee Protections (Sections 2101(a))

Check here if the state elects to use funds provided under Title XXI only to provide expanded eligibility under the state‟s Medicaid plan.

12.1. Eligibility and Enrollment Matters with 42 CFR 457.1120.

The Iowa Department of Human Services uses the same appeal process for all of its programs, including Medicaid and hawk-i eligibility and enrollment. This process is detailed in Attachment 9.

12.2. Health Services Matters

Please describe the review process for health services matters that comply with 42 CFR 457.1120.

The state is using the Statewide Standard Review. Section 514I.2(10) of the Iowa Code requires all participating health plans to be licensed by the Iowa Division of Insurance. All hawk-i enrollees receive services from health insurance issuers subject to state health insurance law. Managed care organizations are subject to Iowa Code Chapter 514B and indemnity health insurance carriers are subject to Iowa Code Chapters 505, 514. All health services are subject to an external review as described in Iowa Code Chapter 514J. See Attachment 10.

12.3. Premium Assistance Programs If providing coverage through a group health plan that does not meet the requirements of 42 CFR 457.1120, please describe how the state will assure that applicants and enrollees have the option to obtain health benefits coverage other than through the group health plan at initial enrollment and at each redetermination of eligibility.