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

Effective Date:

Approval Date: 21 address is found, the letter will be mailed to the family. The family will be given 10 calendar days to respond. The 45-day processing period will begin the day the case is reactivated. We will be electronically opening an application. The two, ten day periods will fall within that 45 days.

Children will be taken off the waiting list on a first come-first serve basis, regardless of medical condition or income level.

CMS will be notified before any freeze is put into place or any waiting list is initiated. There will also be public notice to the families and through the media before such time as a waiting list is to be imposed.

Regarding children who are required to pay enrollment fees in order to reenroll, the enrollment fee is part of the enrollment process. Failure to pay the enrollment fee is tantamount to not completing the enrollment process. Should the enrollment fee not be paid for reenrollment, the child would be denied reenrollment and would have to go onto the waiting list. Children who have applied and found eligible for the program and are placed on the waiting list for any reason, do not have to pay the enrollment fee until they are permitted to go off the waiting list and enroll in the program. At that point in time, if their family income so dictates, they must pay the enrollment fee to enroll in the program.

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)) (42CFR 457.350(a)(1) and 457.80(c)(3))

Income limits for eligibility for Title XXI are higher than those for Title XIX for children ages six through 18. Screening determines eligibility under the appropriate program. During the application process, the existing Title XIX Eligibility Information System (EIS) are queried to ascertain if the child has Medicaid coverage. The application is first processed for Title XIX eligibility; Title XXI will be pursued only if the child is ineligible for regular Title XIX services, and only for children without existing health care coverage. Income will be assessed at application and at annual redetermination of eligibility. All eligibility in Medicaid and Title XXI is continuous for 12 months without regard to income.