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

Effective Date:

Approval Date: 12 Section 4. Eligibility Standards and Methodology. (Section 2102(b))

Check here if the state elects to use funds provided under Title XXI only to provide expanded eligibility under the state’s Medicaid plan, and continue on to Section 5.

4.1. The following standards may be used to determine eligibility of targeted low- income children for child health assistance under the plan. Please note whether any of the following standards are used and check all that apply. If applicable, describe the criteria that will be used to apply the standard. (Section 2102)(b)(1)(A)) (42CFR 457.305(a) and 457.320(a))

4.1.1.

Geographic area served by the Plan: This State Plan applies to the entire State of Idaho. 4.1.2.

Age: Children are eligible from birth through the month of the 19th birthday. 4.1.3.

Income: Children with family incomes over 133% through 185% FPL are eligible for Idaho’s stand-alone SCHIP under Title XXI. Children who have family incomes over 100% through 133% FPL are eligible for Idaho’s Medicaid- expansion SCHIP under Idaho’s Title XIX State Plan from the month of their 6th birthday through the month of the 19th birthday. 4.1.4.

Resources (including any standards relating to spend downs and disposition of resources): There are no resource limits for children served by the plan. 4.1.5.

Residency (so long as residency requirement is not based on length of time in state) : Children served are residents of the State of Idaho.

4.1.6.

Disability Status (so long as any standard relating to disability status does not restrict eligibility): No child will be denied eligibility based on disability status. If the child receives SSI, the child will be denied coverage based on their eligibility for Medicaid, not for reasons of disability status. 4.1.7.

Access to or coverage under other health coverage: A child will be ineligible for coverage under this plan if they have access to or are enrolled in other health coverage, including the following scenarios. • The child is covered by creditable health insurance at the time of application. • The child has been voluntarily dropped from creditable coverage in the six months preceding application with the intention of qualifying for public coverage.