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

Effective Date:

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Approval Date: 4.3.1 Describe the state’s policies governing enrollment caps and waiting lists (if any). (Section 2106(b) (7)) (42CFR 457.305(b))

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The following procedures will be used to determine when the State might need to consider options for containing enrollment and expenditures to ensure that Indiana’s budget or annual appropriation is not exceeded. This process was approved by the Children’s Health Policy Board in the spring of 2000.

The CHIP office will analyze current and past MCHIP and CHIP enrollment in order to determine future enrollment trends and projected enrollment levels. CHIP expenditures will be estimated for MCHIP and CHIP based on previous expenditures and will monitor projected expenses to determine their impact on the budget.

Enrollment and expenditure projections will be utilized to develop an estimate of how many enrollees the State can afford to cover in CHIP and then when to consider implementing mechanisms to ensure that the budget or annual appropriation is not exceeded. Budget limitations may be the result of the state appropriation or the annual federal allocation. If either the state appropriation or the federal allocation is exceeded, the state could choose to:

Allocate additional funds from another source or limit enrollment or expenditures to remain within the original state appropriation or federal allocation by pursuing one of the following options:

Cover CHIP at the Medicaid match rate once Title XXI funds are exhausted

Establish a waiting list for CHIP

Change the benefit package for CHIP

Implement cost-sharing for CHIP to a maximum of 5% of a family’s income.

The State will inform CMS if an enrollment cap is implemented.

4.4. Describe the procedures that assure that:

4.4.1. Through the screening procedures used at intake and follow-up eligibility determination, including any periodic redetermination, that only targeted low- income children who are ineligible for Medicaid or not covered under a group health plan or health insurance coverage (including access to a state health benefits plan) are furnished child health assistance under the state child health plan. (Sections 2102(b) (3) (A) and 2110(b) (2) (B)) (42 CFR 457.310(b) (42CFR 457.350(a) (1)) 457.80(c) (3))

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. The ICES system has a systematic approach to screening and enrolling an enrollee into the appropriate aid category.

Before an application will be approved, income of a parent or guardian must be verified