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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: 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. Three primary methods of third party liability policy gathering will be utilized:  Absent parent data match using data from the State Wage Information Collection Agency  Match with data from the Department of Defense that shows CHAMPUS coverage for dependents  Match through Health Management Systems which matches claims information from the IndianaAIM system with insurance information from private insurance policies.  The State will utilize the employment section of the application form to identify children who are eligible for dependant coverage under the state employees’ health plan.

4.4.2. The Medicaid application and enrollment process is initiated and facilitated for children found through the screening to be potentially eligible for medical assistance under the state Medicaid plan under Title XIX. (Section 2102)(b)(3)(B)) (42CFR 457.350(a) (2))

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.

4.4.3. The State is taking steps to assist in the enrollment in CHIP of children determined ineligible for Medicaid. (Sections 2102(a) (1) and (2) and 2102(c) (2)) (42CFR 431.636(b) (4))

Children who are found not eligible for Medicaid under Title XIX, are enrolled in MCHIP if they are up to 150% FPL and do not have other insurance. Title XIX, rather than Title XXI, is used to provide services for children who are under 150% FPL but who have other health insurance. The enhanced match does not apply for these children since they do not fall under the targeted low-income definition due to their other insurance coverage. Children who are above 150% but not more than 300% FPL, who do not have other health coverage and who meet the other CHIP eligibility requirements are enrolled in CHIP if the parent/guardian agrees to the cost sharing obligation.

4.4.4. The insurance provided under the state child health plan does not substitute for coverage under group health plans. Check the appropriate box. (Section 2102)(b)(3)(C)) (42CFR 457.805) (42 CFR 457.810(a)-(c))