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

Effective Date:

Approval Date: September 19, 2002 19 XIX. (Section 2102)(b)(3)(B)) (42CFR 457.350(a)(2))

The single application process described above assures that all children applying for KidCare are considered for eligibility under Title XIX. Where they are found to be eligible for Medicaid, they are enrolled in KidCare Assist under Title XIX or Title XXI as appropriate. A child who is pregnant at the time of application for KidCare or an infant whose mother is eligible under Title XIX at the time of birth is enrolled in KidCare Moms and Babies.

If a child enrolled in KidCare Share or KidCare Premium becomes pregnant, she is terminated from either plan and enrolled under KidCare Moms and Babies (Title XIX funded) under the following circumstances: 1) upon the request of the pregnant child or her family she is reviewed for Title XIX eligibility, and if found eligible, is enrolled in KidCare Moms and Babies; 2) upon reapplication for KidCare Share or KidCare Premium, a pregnant child is enrolled in KidCare Moms and Babies when the 12 month eligibility period for KidCare Share or KidCare Premium ends; or 3) upon the family seeking to enroll the infant in KidCare, the State reviews the mother’s status and if determined to be eligible under Title XIX, both mother and infant are enrolled in KidCare Moms and Babies.

When a KidCare Share or Premium enrolled child becomes pregnant and is therefore likely to be eligible for Medicaid under Title XIX, she will be enrolled in KidCare Moms and Babies after her family income has been reviewed to determine that she in fact meets the KidCare Moms and Babies financial eligibility criteria. The time it takes to complete the review will depend on the responsiveness of the pregnant girl and her family. Once any necessary information is obtained, the financial review can be completed in a day or two. Once Medicaid eligibility is determined, it may be established retroactively for three months, pursuant to Medicaid policy. She will also be disenrolled from KidCare at that time; therefore, benefits will continue in an uninterrupted fashion.

The State has great concern that coverage not be interrupted because a family fails to provide information necessary to make a determination of the child’s eligibility for Medicaid when her eligibility for KidCare Share or Premium remains in force. Therefore, the State will maintain the child’s enrollment in KidCare