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6 State Action to Avoid Crowd Out

• The State monitors for substitution by asking insurance history questions on the application form, which is then tracked by the State's third-party administrator.

• For children applying to the hawk-i program, a match with insurance carriers is done to determine if the children have other health care coverage. For all hawk-i applicants, the State will monitor the length of time between when other coverage ended and the time the child applied, to determine if additional strategies are needed.

• The State has also included a 30-day waiting period of uninsurance for CHIP coverage, only for children with family incomes above 250 percent of the FPL up to 300 percent of the FPL. Children with lower family incomes will not be subject to the 30-day waiting period. The list of exceptions to the 30-day waiting period includes:

o lack of affordability , if the child’s premiums are greater than 5 percent of the family’s income; o existence of a chronic or emergent medical condition; o current coverage is through an individual plan rather than under group coverage; o for domestic violence, divorce or death of a parent; o the involuntary loss of employment or change in employment; o the child reaches a maximum lifetime coverage amount; o coverage under COBRA expires; and o a discontinuation of the availability of dependent coverage.

Coordination between CHIP and Medicaid

• All applications are screened for Medicaid eligibility and the presence of health insurance coverage. The hawk-i application is also used as an application for Medicaid benefits. If it appears that the child is eligible for Medicaid, the hawk-i application will be forwarded to the Eligibility Worker for obtaining the social security number, any necessary child support information, and an eligibility review.

• If the applicant is not Medicaid eligible, hawk-i eligibility is determined. If the child has health insurance coverage and is not Medicaid-eligible, coverage under hawk-i is denied.

• When an application is screened for Medicaid eligibility and it is determined that the 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 canceling Medicaid accompanies the paper referral. This notice contains a calculation showing how Medicaid ineligibility due to excess income was determined.