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

Effective Date:

Approval Date: 20

At the point of application, a registration number will be filed so that the applications can be sequenced chronologically according to the date originally registered in EIS. The applications will be reactivated on a first-come, first-serve basis according to this chronological order. When a child’s application is reactivated, he or she is removed from the waiting list. The family is mailed notification that its application has been re-opened. The notification letter asks that the family confirm its address and uninsurance status and to return it to the state. This permits the state to act on the family’s behalf and reactivate the application. A maximum of 45 days processing time will be allowed for the application to be considered and for the family to provide any needed information.

If the family does not return the reactivation notice the county checks agency records to see if an address change has occurred and will mail a second notice. The county DSS acts on the returned notice to complete the application. The DSS notifies the family if there is any enrollment fee due and the family is asked to pay it. The family is officially notified of the outcome of the reopened application and the child(ren)’s record is transmitted to the claims processing agent. Benefits begin the month the application was "re-activated" and will continue for 12 consecutive months (e.g. the month of ‘re-activations’ is month 1 of the 12 months).

Should a family not reply within 45 days, the "re-activated" application is denied: the number of slots represented by the children in the family become available. The children do not return to the waiting list. The family can reapply at any time.

In the event that the budget shortfall or growth cap is eliminated, the backlogged wait-listed children must be enrolled in the program before the process returns to one with no waiting list.

If a case on the waiting list is re-activated within 3 months, then families will reaffirm their insurance status. The State will use the income that was verified when applicant first applied to determine eligibility when re- activated. If a case is on the waiting list longer than 3 months, then the insurance and income will be reaffirmed at re-activation.

All families will receive a reactivation letter that will ask them to respond to the county DSS within 10 calendar days. If the initial letter is returned to the county DSS because it couldn’t be delivered, the county will follow established procedures to determine a current address. Once a current