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

Effective Date:

Approval Date: 37 Measure 2.1.1: By September 1, 1998, systems changes related to the new income eligibility guidelines for Medicaid/Kids Connection will be functioning.

Measure 2.1.2: On December 31, 1999, a report will be issued detailing numbers of children enrolled by county/region from the N-Focus data.

Measure 2.1.3: On December 31, 2000, a report will be issued detailing numbers of children enrolled by county/region from the N-Focus data.

Measure 2.2.1: By September 1, 1998, 2 additional eligibility staff will be hired in the HHSS system.

Measure 2.2.2: By September 1, 1999, 17 eligibility staff will be hired to accommodate the increased numbers of children enrolling in Medicaid/Kids Connection.

Measure 2.3.1: By September 1, 1998, training will have been offered in all six HHS service delivery areas.

Measure 2.3.2: By September 1, 1999, training will be offered in all six HHS service delivery areas to accommodate the new staff hired to enroll the increased numbers of children.

Measure 2.4.1: By September 1, 1998, develop and implement a shortened single purpose eligibility form for applications for Medicaid/Kids Connection.

Measure 2.4.2: By January 1, 1998, identify and develop a training plan for non-HHS eligibility sites that will accept applications for Medicaid/Kids Connection.

Measure 2.4.3: By April 1, 1999, 3 non-HHS eligibility sites (1 each location) will accept applications for Medicaid/Kids Connection.

Measure 2.4.4: By January 1, 2000, at least 7 additional non-HHS sites (one each location) will accept applications for Medicaid/Kids Connection.

Measure 3.1.1: By September 1, 1999, 70% of the children identified as mandatory for managed care under the Phase I Plan will be enrolled into managed care within 90 days following the date they are found eligible for Medicaid.

Measure 3.1.2: By September 1, 2000, 70% of children identified as mandatory for managed care will be enrolled into managed care within 90 days following the date they are found eligible for Medicaid.