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

Effective Date:

Approval Date: 23 or employer-sponsored, creditable health insurance plan on the date of enrollment into the program, and is ineligible for Medicaid, Medicare or other federal government sponsored insurance. Cases that qualify due to dropping private insurance will be electronically coded so the state may determine if the “crowd out” rate is impacted. Each case is processed through a system to match the family to the primary insurance providers in North Carolina. It is the same system used for Medicaid. In addition, the claims processor runs periodic screens to double check the child’s insurance coverage. If creditable insurance coverage is found, the claim is denied and the case is referred to the Division of Medical Assistance, Program Integrity Fraud Unit.

4.4.4.2. Coverage provided to children in families over 200% and up to 250% FPL: describe how substitution is monitored and identify specific strategies to limit substitution if levels become unacceptable. 4.4.4.3. Coverage provided to children in families above 250% FPL: describe how substitution is monitored and identify specific strategies in place to prevent substitution. 4.4.4.4. If the state provides coverage under a premium assistance program, describe:

The minimum period without coverage under a group health plan, including any allowable exceptions to the waiting period.

The minimum employer contribution.

The cost-effectiveness determination.

4.4.5 Child health assistance is provided to targeted low-income children in the state who are American Indian and Alaska Native. (Section 2102)(b)(3)(D)) (42 CFR 457.125(a))

All children in the state who are eligible for assistance will be targeted through outreach efforts specifically outlined in Section 5. Organizations that provide outreach to the Native American population will also be targeted. Representation from the Commission on Indian Affairs and the Eastern Band of the Cherokee serve on the Outreach Committee and assisted in the