Page 5

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

Effective Date:

Approval Date: September 19, 2002 5

Estimated Number of Optional Targeted Low Income Children and Estimated Number of Potentially Medicaid-Eligible Children By Age and Family Income Relative to the Federal Poverty Level: Illinois. 1993 – 1996 Average POVERTY LEVEL

AGE

TOTAL 0 – 5 6 – 13 14 – 17 186 – 200 2,800 5,400 3,700 11,900 151 – 185 13,300 17,100 11,200 41,600 134 – 150 6,300 8,000 5,300 19,600 100 – 133

17,500 10,600 28,100 50 – 99

< 50 (52,500) (40,400) (12,300

TOTAL

113,500

Illinois did not identify a reason to further target children by race, ethnicity or geography. In addition, an estimated 105,200 children are potentially eligible for Medicaid (under the income standards in effect March 31, 1997) and will be targeted for enrollment in the Medicaid program through intensive community-based outreach efforts.

These estimates were derived by aggregating the 1993 through 1996 Current Population Surveys and cross-tabulating age (in single years) by income relative to the federal poverty level, controlling for insurance status. Insurance status was determined by an algorithm that combined the responses to several survey items in order to determine that the child was uninsured.

Effective August 12, 1998, Illinois began enrolling children under Phase II of its Children’s Health Insurance Program. Phase II expands the new children’s health insurance program, KidCare, under Title XXI for