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Model Application Template for the State Children’s Health Insurance Program

Effective Date:

10 Approval Date:

Section 4. Eligibility Standards and Methodology. (Section 2102(b))

Check here if the state elects to use funds provided under Title XXI only to provide expanded eligibility under the state’s Medicaid plan, and continue on to Section 5.

4.1. The following standards may be used to determine eligibility of targeted low- income children for child health assistance under the plan. Please note whether any of the following standards are used and check all that apply. If applicable, describe the criteria that will be used to apply the standard. (Section 2102)(b)(1)(A)) (42CFR 457.305(a) and 457.320(a))

4.1.1.

Geographic area served by the Plan: Statewide

4.1.2.

Age: Individuals must be under 19 years of age.

4.1.3.

Income: The upper income limit for Title XXI is 200% FPL.

4.1.4.

Resources (including any standards relating to spend downs and disposition of resources):

4.1.5.

Residency (so long as residency requirement is not based on length of time in state): To be eligible for MaineCare, a child must be a resident of the State of Maine.

4.1.6.

Disability Status (so long as any standard relating to disability status does not restrict eligibility):

4.1.7.

Access to or coverage under other health coverage: Children must be uninsured to be eligible for Title XXI funded coverage.

4.1.8.

Duration of eligibility: In general, a child who has been determined eligible for MaineCare shall remain eligible for 12 months unless the child attains the age of 19 or is no longer a resident of the State. Eligibility is redetermined prior to the end of each twelve month period. A child may be ineligible for a subsequent 12-month period of eligibility for a specified length of time (as described in section 8.7) for nonpayment of premiums.

4.1.9.

Other standards (identify and describe):

The Bureau of Family Independence MaineCare Eligibility Manual sets forth the eligibility policies for Titles XIX and XXI. Sections 1230 and 9000.02 of the Manual clearly state that