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

Effective Date:

Approval Date: 19 Check here if this section does not apply to your state.

Effective January 1, 2006, the enrollment growth of Title XXI, Health Choice, is limited to three percent every six months. In the event that enrollments in the program exceed the three percent cap or the available budget, The Secretary may halt new enrollments until such time as enrollment levels are administratively deemed to be budgeted within the legislated parameters. Notifications will be provided to the US DHHS CMS 45 days in advance of the implementation of any enrollment cap. Public notification will be announced to the current enrollees by letter 30 days prior to the imposition of an enrollment cap and to the news media no later than 20 days before a new enrollment cap is to be implemented. The purpose of the plan is to limit enrollment in a manner that does not impose an extra burden on families to file multiple applications and it allows children to enroll as slots become available rather than waiting for a pre-established date. The initial closure will last a minimum of two months to allow the first full set of re-enrollments to have grace period and to build a safety buffer of open slots.

Enrollments shall be permitted as follows:

Families will continue to file applications and counties will determine eligibility as usual. If a child is determined eligible for Medicaid, then the application is approved and the child is issued benefits. If the child is determined ineligible for any program, the application is denied. If the child qualifies for NC Health Choice, the application will be denied and the family will be notified that the child qualifies for the program but that no funds are available for the program. The state’s Eligibility Information System (EIS) will establish a computerized waiting list and add the child to the waiting list. Information about the child will not be transmitted to the claims processing agent until such time as the program enrollment is reopened.

Should the family be an existing NCHC family and re-enroll during the 10-day grace period, the children will continue to have coverage.

Reactivation of applications from the waiting list.

When the NCDMA determines that it is financially possible to allow for new enrollees, it will notify the Division of Information Resources Management (DIRM) of the number of slots that can be filled. US DHHS CMS will be notified on the same day that DIRM receives its notification.