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Model Application Template for the State Children’s Health Insurance Program
Effective Date:
Approval Date: 13 • The child is eligible under Idaho’s Title XIX State Plan. • The child is eligible to receive health insurance benefits under Idaho’s state employee benefit plan.
4.1.8.
Duration of eligibility: The duration of eligibility is 12 months unless the child is terminated for one of the reasons described below. • The child loses his or her Idaho residency. • The child attains 19 years of age. • The child becomes eligible for and is enrolled in Medicaid. • The child’s parent or adult who is legally responsible for the child’s health care makes a written request to terminate coverage. • The application is found to have inaccurate information which effected an incorrect eligibility determination. • The child dies.
• 4.1.9.
Other standards (identify and describe): • At the time of application, a) the child must not be a patient in an institution for mental diseases, or b) an inmate of a public institution. • The Social Security number, proof of application for a Social Security number or resident alien card number must be provided for applicants who are requesting coverage. Individuals on the application that are not requesting coverage are not required to provide Social Security numbers. • The State does not exclude individuals based on citizenship or nationality, to the extent that the child is a U.S. citizen, U.S. national or qualified alien (as defined at section 431 of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996, as amended by the BBA of 1997, except to the extent that section 403 of PRWORA precludes them from receiving Federal means-tested public benefits).
4.2. The state assures that it has made the following findings with respect to the eligibility standards in its plan: (Section 2102)(b)(1)(B)) (42CFR 457.320(b))
4.2.1.
These standards do not discriminate on the basis of diagnosis. 4.2.2.
Within a defined group of covered targeted low-income children,