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

Effective Date:

12 Approval Date: completion.

In summary, MaineCare policy requires eligibility specialists to review all applications, denials, closings, changes in MaineCare Title XIX funded coverage for Title XXI funded coverage and vice versa.

Families are allowed to purchase coverage for a child whose family income at the end of the 12-month enrollment period exceeds 200% of FPL. The purchase of coverage is available for 18 months. The child’s family is responsible for paying the full cost of the coverage, which covers the benefit cost plus an administrative cost not to exceed the maximum allowable under COBRA.

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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In order to provide health coverage to as many children as possible within the fiscal constraints of the program budget (as defined in the Balanced Budget Act of 1997), the maximum eligibility level is subject to adjustment by the Commissioner of the Department dependent on the fiscal status of the program. If program expenditures are anticipated to exceed the program budget, the Commissioner shall reduce the maximum eligibility level to the extent necessary to bring the program expenditures within the program budget. If expenditures are expected to fall below the program budget, the Commissioner shall increase the maximum eligibility level to the extent necessary to provide coverage to as many children as possible within the fiscal constraints of the program budget.

Children of higher income may not be covered unless children of lower income are also covered. If the Commissioner has reduced the maximum eligibility level, children of higher income may be disqualified at the end of the twelve month enrollment period, but not during the twelve-month period.

4.4. Describe the procedures that assure that:

4.4.1. Through the screening procedures used at intake and follow-up eligibility determination, including any periodic redetermination, that only targeted low-income children who are ineligible for Medicaid or not covered under a group health plan or health insurance coverage (including a state health benefits plan) are furnished child health assistance under the state child health plan. (Section 2102)(b)(3)(A))