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

Effective Date:

11 Approval Date: Social Security numbers are not required for children applying for Title XIX and XXI coverage.

4.2. The state assures that it has made the following findings with respect to the eligibility standards in its plan: (Section 2102)(b)(1)(B)) (42CFR 457.320(b))

4.2.1.

These standards do not discriminate on the basis of diagnosis.

4.2.2.

Within a defined group of covered targeted low-income children, these standards do not cover children of higher income families without covering children with a lower family income.

4.2.3.

These standards do not deny eligibility based on a child having a pre-existing medical condition.

4.3. Describe the methods of establishing eligibility and continuing enrollment. (Section 2102)(b)(2)) (42CFR 457.350)

All administrative processes are designed by the Department of Health and Human Services to be seamless for children applying for MaineCare. As such, all enrollment and eligibility processes are the same for Title XIX and Title XXI, with the only discernable difference being premium billing for those Title XXI children at 151% through 200% FPL.

There is one application and renewal form for families and children who want to apply for MaineCare coverage. The Department of Health and Human Services, Bureau of Family Independence eligibility specialists determine if applicants are eligible for Title XIX or XXI coverage depending on family income.

Eligibility applications may be completed at any of the Department’s regional offices or at home and returned by mail. No interview is necessary.

The Bureau of Family Independence notifies families of their eligibility by mail. Those eligible Title XXI children at 151% through 200% FPL are, in addition to their enrollment cards, mailed monthly premium bills (please see Section 8.2).

A child who has been determined eligible for MaineCare remains eligible for a 12 month enrollment period 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 12 month period. Written notification is sent to each family by the Bureau of Family Independence containing the end date of the child’s 12- month enrollment period and a renewal form to be returned by mail upon