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Application for the State of Indiana Children’s Health Insurance Program Amendment #7

Effective Date:

13

Approval Date:

Children under age 3 receive continuous eligibility for 12 months, regardless of changes in income.

An exception to this is allowed if an individual reports a change in income which would qualify the individual for Medicaid.

4.1.9.

Other standards (identify and describe):

To be eligible for CHIP, families must agree to cost-sharing requirements.

The CHIP program is also permitted to adjust eligibility requirements based upon available resources.

Applicants must provide a Social Security Number in order to be eligible for the program, as permitted in 42 CFR 457.340.

4.2. The state assures that it has made the following findings with respect to the eligibility standards in its plan: (Section 2102) (b) (1) (B)) (42CFR 457.320(b))

4.2.1.

These standards do not discriminate on the basis of diagnosis. 4.2.2.

Within a defined group of covered targeted low-income children, these standards do not cover children of higher income families without covering children with a lower family income. 4.2.3.

These standards do not deny eligibility based on a child having a pre- existing medical condition.

4.3. Describe the methods of establishing eligibility and continuing enrollment. (Section 2102)(b)(2)) (42CFR 457.350)

The application process and eligibility determination process for the CHIP program is integrated into the application and eligibility determination process for Hoosier Healthwise. Eligibility determinations for MCHIP (Title XIX) and CHIP (XXI) are made by the DFR. Applicants are first screened for eligibility under Title XIX, and if found ineligible, they will be screened for eligibility under Title XXI. Before an application will be approved, income of a parent or guardian must be verified by supporting documentation from the payer. Acceptable items for verifying earnings include: pay stubs, statements from employers, or a wage verification form that is completed by employers. Indiana will conduct follow-up screening to identify when coverage is available through another plan. CHIP will be discontinued beginning the day the child receives other creditable coverage.

Families who apply for benefits will be advised of the cost sharing requirements under CHIP, and, to be considered for eligibility under CHIP, they must agree to meet the cost-sharing requirements if the child is found eligible. In addition a conditional approval notice will be sent to the family and a record will be sent to the premium collection vendor. Once the first premium payment is made, the child becomes enrolled in the program.