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

Effective Date:

Approval Date: 29 analysis revealed that the leading causes of emergency department visits were for otitis media, fever and upper respiratory infections. Materials have been developed in both English and Spanish helping parents to know what to do, when to see their child’s doctor and when to go to the emergency room. Additional materials have been developed to encourage families to choose a provider to become their child’s medical home so that they will always have someone who knows their child to turn to for help as well information on how to prepare for a doctor’s visit so that it will work for the child.

Efforts have also been undertaken to identify children with asthma and to assure that they are receiving all the help they need to prevent emergency episodes. One of the major foci of the program right now is medical management: identification of frequent or high cost episodes and outreaching health information to those families.

5.2. Coordination of the administration of this program with other public and private health insurance programs: (Section 2102(c)(2))

The strategies for outreach/promotion and marketing, and eligibility determination/enrollment are identical for both the Title XIX and XXI programs as outlined in 5.1. The Division of Medical Assistance administers the program in concert with the local Departments of Social Services for determination of eligibility. Children are determined eligible or ineligible for Title XIX using the same application form as for Title XXI.

Children who are not eligible for Title XIX are evaluated for Title XXI eligibility and automatically enrolled if income criteria are met. Outstationed eligibility staff, including those placed at Federally Qualified Health Centers and Disproportionate Share Hospitals, accepts applications for both Title XIX and XXI programs through a common process.

Applications are made available on self-service displays in easy access locations.

An enrollee in the Program who loses eligibility due to an increase in family income above 200% FPL and up to and including 225% FPL may purchase at full premium cost, continued coverage under the Program for a period not to exceed one year beginning on the date the enrollee becomes ineligible under the income requirements for the Program. The same benefits, co-payments, and other conditions of enrollment shall