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

Effective Date:

13 Approval Date: (42CFR 457.350(a)(1) and 457.80(c)(3)) As noted in Section 4.3, the same application and enrollment process is used by all families applying for coverage under MaineCare. A child applying for coverage under MaineCare is first screened by Bureau of Family Independence eligibility specialists for eligibility under Title XIX. Those children deemed ineligible under Title XIX are then screened for eligibility under Title XXI.

Applicants are asked to provide insurance information as part of the application process. Specific questions on the application ask about children in the household who: (1) currently have insurance; (2) have lost health insurance in the last 3 months; and (3) could be added to the State employee health insurance plan. Depending on the answer to these questions, Bureau of Family Independence eligibility specialists will determine if an applicant is eligible for Title XXI funded coverage.

This same process is followed for subsequent eligibility determinations.

4.4.2. The Medicaid application and enrollment process is initiated and facilitated for children found through the screening to be potentially eligible for medical assistance under the state Medicaid plan under Title XIX. (Section 2102)(b)(3)(B)) (42CFR 457.350(a)(2))

Please see Section 4.4.1 above.

4.4.3. The State is taking steps to assist in the enrollment in SCHIP of children determined ineligible for Medicaid. (Sections 2102(a)(1) and (2) and 2102(c)(2)) (42CFR 431.636(b)(4))

Please see Section 4.4.1 above.

4.4.4 The insurance provided under the state child health plan does not substitute for coverage under group health plans. Check the appropriate box. (Section 2102)(b)(3)(C)) (42CFR 457.805) (42 CFR 457.810(a)-(c))

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

Applicants are asked to provide insurance information as part of the application process. Specific questions on the application ask about children in the household who: (1) currently have insurance; (2) have lost health insurance in the last 3 months; and (3) could be added to the State