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

Effective Date:

Approval Date: September 19, 2002 21 because of availability of KidCare Share and KidCare Premium, persons or employers are inappropriately dropping privately funded coverage.

4.4.4.2. Coverage provided to children in families over 200% and up to 250% FPL: describe how substitution is monitored and identify specific strategies to limit substitution if levels become unacceptable.

4.4.4.3. Coverage provided to children in families above 250% FPL: describe how substitution is monitored and identify specific strategies in place to prevent substitution.

4.4.4.4. If the state provides coverage under a premium assistance program, describe:

The minimum period without coverage under a group health plan, including any allowable exceptions to the waiting period.

The minimum employer contribution.

The cost-effectiveness determination.

4.4.5 Child health assistance is provided to targeted low-income children in the state who are American Indian and Alaska Native. (Section 2102)(b)(3)(D)) (42 CFR 457.125(a))

Any American Indian or Alaska Native child who applies for KidCare and who meets the eligibility requirements will be enrolled in KidCare. No premiums or co-payments are required for American Indian or Alaska Native children.

There is a single American Indian health center in the State, which is located in Chicago. This health center is recognized as a Federally Qualified Health Center (FQHC) under the Department’s Title XIX program. The facility provides primary care services and makes referrals for other services. At the inception of KidCare, the Department consulted with this facility concerning KidCare outreach and enrollment strategies that would be appropriate for reaching American Indian Children. Subsequent attempts to solicit input from American Indian groups have been unsuccessful.