Page 50

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

Effective Date:

Approval Date: 50 Additional staff would be needed to administer the Title XXI program, support eligibility workers, provide technical assistance to presumptive eligibility providers, approve providers, perform eligibility functions, and work with providers in the process. Outreach costs include targeted outreach, printing, mailings, computer system changes, computer support for other agencies, and managed care enrollment broker contract costs.

Administrative expenditures are anticipated to be broken down as follows:

1st full year 2nd year and thereafter Eligibility Determination 63% 67% Outreach 14% 15% Managed Care Enrollment 7% 9% Administration 5% 6% Systems Costs 11% 3% Total

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Page 50

Official source

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

Effective Date:

Approval Date: 50 Additional staff would be needed to administer the Title XXI program, support eligibility workers, provide technical assistance to presumptive eligibility providers, approve providers, perform eligibility functions, and work with providers in the process. Outreach costs include targeted outreach, printing, mailings, computer system changes, computer support for other agencies, and managed care enrollment broker contract costs.

Administrative expenditures are anticipated to be broken down as follows:

1st full year 2nd year and thereafter Eligibility Determination 63% 67% Outreach 14% 15% Managed Care Enrollment 7% 9% Administration 5% 6% Systems Costs 11% 3% Total