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

Effective Date:

Approval Date: 66

3. DHS completes an electronic or paper referral and sends the referral to hawk-i. (This occurs even if the Income Maintenance Worker is simultaneously determining Medically Needy eligibility with a spenddown.

When there is an existing Medicaid case at the DHS office 1. An ongoing Medicaid case is canceled due to excess income. 2. DHS completes an electronic or paper referral and sends the referral to hawk-i. (This occurs even if the Income Maintenance Worker is simultaneously determining Medically Needy eligibility with a spenddown.

For both situations, the TPA: 1. Logs the referral into the TPA system. 2. Proceeds with the hawk-i eligibility determination.