400.19 CHIP (CHILDREN’S HEALTH INSURANCE PROGRAM) – COE-099

CHIP provides health insurance coverage to uninsured children to age 19 whose household income does not exceed the MAGI-equivalent income limit of 209% FPL. Uninsured children are covered by CHIP based on age/MAGI household income as follows: AGE OF CHILD CHIP FPL INCOME RANGE (Post-ACA) CHIP MAGI-EQUIVALENT OR FPL INCOME RANGE CHILDREN TO AGE 1 185% FPL – 200% FPL 194% ME – 209% ME CHILDREN AGE 1 TO AGE 6 133% FPL – 200% FPL 143% ME – 209% ME CHILDREN AGE 6 TO AGE 19 133% FPL – 200% FPL 133% FPL – 209% ME CHIP coverage is available to uninsured children who meet the income requirements. Uninsured means coverage that is not creditable, i.e., the child does not have minimal essential medical coverage under any other group or individual health plan, including Medicaid or Medicare. Health plans that don’t count as minimal essential coverage includes those that provide only limited medical services such as dental care or vision care, coverage that is only for a specific disease or condition or a plan that offers only discounts on medical services. • CHIP eligibility will be denied to any child under age 19 who is covered by a third-party creditable health plan at the time of application, regardless of who pays for the coverage. • Children who start health insurance coverage after approval for CHIP cannot be terminated until their next review. Receipt of health insurance is not an exception to the continuous eligibility requirement for children. The following provisions are also applicable to CHIP: • Children must be tested for Medicaid and fail to qualify solely due to household income before being tested for CHIP. (Children with third party health insurance are not eligible for CHIP and are therefore not tested for CHIP.) • The benefit start date beginning on and after December 1, 2016, is the month following the month of application if the child is otherwise eligible. There is no other retroactive coverage provision in CHIP, with the following exception: o Infants for whom application is made within 31 days of birth, including the day of birth, may have retroactive CHIP coverage back to the date of birth. o The infant will be tested first for Medicaid coverage. If not Medicaid eligible, the infant will be tested for CHIP eligibility retroactive to the date of birth. • Prior to 12/01/2016, the CHIP start date was based on the date the case was authorized by a supervisor. If a CHIP case was authorized by the 3rd day of the current month, eligibility could be established effective with the current month. • CHIP policy regarding pregnancy retains the following provisions: o The needs of an unborn are not counted in the CHIP household size for any child qualifying for CHIP. This is a Medicaid provision only. o There is no deemed automatic coverage for an infant born to a CHIP- eligible mother. An application for the newborn is needed. However, since the income liberalization exists for pregnant minors that allow all income of the pregnant minor to be disregarded, all pregnant minors are Medicaid eligible as outlined in 400.17, Pregnant Women (COE-088). An otherwise CHIP-eligible minor who is pregnant at the time of application must be coded in MEDS as pregnant and MEDS will approve the pregnant minor in Medicaid COE-088 for the expected duration of her pregnancy and post-partum period. o A CHIP minor who is reported as pregnant by the CCO, self-reported or otherwise discovered by the Regional Office must be handled as outlined in Chapter 101 in 101.19.01, Transitioning the Pregnant CHIP Child to Medicaid COE-088. NOTE: If the pregnancy is discovered in the month of the expected birth or after, do not transition the CHIP child to Medicaid. CHIP will cover the birth of the child in such an instance. There is no deemed automatic coverage for the infant born to a CHIP eligible mother. An application for the newborn is needed.