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Model Application Template for the State Children’s Health Insurance Program
Effective Date:
Approval Date: September 19, 2002 45 eligibility will be reviewed and the child will be enrolled in KidCare Assist or KidCare Share, depending on family income, and continued eligibility. KidCare Assist requires no cost sharing and KidCare Share requires minimal co- payments.
The state provides the enrollee with an opportunity for an impartial review to address disenrollment from the program. (42CFR 457.570(c))
As described in Section 12.1, enrollees are afforded the opportunity for an impartial review on eligibility and enrollment matters.
8.8 The state assures that it has made the following findings with respect to the payment aspects of its plan: (Section 2103(e))
8.8.1.
No Federal funds will be used toward state matching requirements. (Section 2105(c)(4)) (42CFR 457.220) 8.8.2.
No cost-sharing (including premiums, deductibles, copays, coinsurance and all other types) will be used toward state matching requirements. (Section 2105(c)(5) (42CFR 457.224) (Previously 8.4.5) 8.8.3.
No funds under this title will be used for coverage if a private insurer would have been obligated to provide such assistance except for a provision limiting this obligation because the child is eligible under the this title. (Section 2105(c)(6)(A)) (42CFR 457.626(a)(1)) 8.8.4.
Income and resource standards and methodologies for determining Medicaid eligibility are not more restrictive than those applied as of June 1, 1997. (Section 2105(d)(1)) (42CFR 457.622(b)(5))
8.8.5.
No funds provided under this title or coverage funded by this title will include coverage of abortion except if necessary to save the life of the mother or if the pregnancy is the result of an act of rape or incest. (Section 2105)(c)(7)(B)) (42CFR 457.475)
8.8.6.
No funds provided under this title will be used to pay for any abortion or to assist in the purchase, in whole or in part, for coverage that includes abortion (except as described above). (Section 2105)(c)(7)(A)) (42CFR 457.475)