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parent or divorce (See Section 4.4.4.), • Children without insurance being served by other health care programs, i.e., WIC, well child, free clinics, federally funded 330 agencies.

Through eligibility determinations, this pool of potential eligible recipients will be channeled to Medicaid or KCHIP as appropriate. The goal is to make eligibility determination and enrollment into KCHIP as simple as possible for the applicant and plan provider while meeting all statutory requirements of Title XXI.

Kentucky uses a joint application process for KCHIP/Medicaid.

The application can be completed by the parent or another caretaker. Many agencies assist families in determining what information is needed and applications can be downloaded from the KCHIP website, obtained by calling a toll free number, or obtained at a variety of localities throughout the state including the local DCBS office, health departments, physician offices, primary care centers, and hospitals. The local Department for Community Based Service Office will determine eligibility for KCHIP and Medicaid.

If the child is determined eligible for KCHIP/Medicaid, the information will be entered into a management information system and an approval notice and medical card will be generated and mailed.

Recertification Recertification will be required every 12 months with requirements for recipients to notify the state within 10 days of any changes in financial or coverage status impacting eligibility. If the recipient is determined to be ineligible for the program due to this change, coverage will be discontinued. These changes will include, but not be limited to, change in family income beyond KCHIP eligibility levels, eligibility for Medicaid coverage, or availability of coverage through employer. KCHIP Medicaid expansion, separate insurance program, and Medicaid will reinstitute the use of a mail-in process for recertification of children effective July 1, 2002.

Families will automatically receive a recertification form for KCHIP by mail, or the DCBS caseworker will contact them by phone. The form and verification of income and care giving expenses are to be provided to the local DCBS office.

If recertification is not returned, a second notice is sent. The case is discontinued if the recipient does not respond after two notices. If the recertification form and required documentation is returned to the office within 30 days after the date of discontinuance, the case will be re-determined based on the information received and the family will not need to complete a new application for benefits.

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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