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

Effective Date:

Approval Date: September 19, 2002 13 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: The plan will be statewide. 4.1.2.

Age: Under 19 years of age. 4.1.3.

Income: The child’s family income is above 133% and at or below 200% of the federal poverty level. Family income considers all persons living in the household, including those that are not applying for benefits. Certain income that is exempt under Title XIX is exempt under Title XXI. This includes the exemption of certain employment-related costs, child care costs, and earned income of children who are not minor parents. 4.1.4.

Resources (including any standards relating to spend downs and disposition of resources): No asset limitation is applied. Met spend down cases are not eligible for KidCare Share or KidCare Premium. 4.1.5

Residency (so long as residency requirement is not based on length of time in state): The child must be a resident of the State of Illinois and a U.S. citizen or qualified legal immigrant. Qualified legal immigrants are non-citizens who meet one of the following categories: 1) Unmarried dependent children of a United States Veteran honorably discharged or a person on active military duty, 2) Refugees under Section 207 of the Immigration and Nationality Act, 3) Asylees under Section 208 of the Immigration and Nationality Act, 4) Persons for whom deportation has been withheld under Section 243(h) of the Immigration and Nationality Act, 5) Persons granted conditional entry under Section