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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: 4.4.4.1. Coverage provided to children in families at or below 200% FPL: describe the methods of monitoring substitution.

Indiana has instituted a number of mechanisms designed to address crowd out. To ensure that CHIP enrollees do not have other health insurance, the State requires that all CHIP recipients attest to the lack of current health care coverage and specify the date of last coverage.

Since the MCHIP program limits family income to 150% of poverty, crowd out is not a significant issue because many of the lower income families do not have the option of employer-based health insurance.

Crowd out is of greater concern under CHIP due to the higher income threshold. As such, Indiana has instituted three-month waiting periods and monthly premiums as crowd out deterrents under the CHIP program. Also provisions included in Public Law 273-1999 prohibit insurers from knowingly or intentionally referring children covered under their dependent coverage policies to the CHIP program.

The Hoosier Healthwise application asks "Did any applicants who do not have health insurance lose their coverage in the last three months? Please tell us why coverage was lost." The choices are:

Loss of employment

Could not afford

Coverage limit reached

Company ended coverage

Non-custodial parent dropped coverage

Divorce

Other

This information (for both approved and denied children) is entered into the Indiana Client Eligibility System (ICES) and monitored for signs of crowd-out among applicants. Applicants who lose coverage involuntarily are not subjected to the three-month waiting period. Denial reasons are tracked, resulting in:

Count of applicants who were denied because they voluntarily dropped coverage but did not wait the required three months before applying

Count of applicants who were denied because they currently carry private insurance

Count of currently enrolled children who are denied because they gained private coverage rendering them ineligible for CHIP. This information is monitored using our aggregated data system, COGNOS.