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

Effective Date:

Approval Date: 4-6 To assist families in enrolling, the Department developed a brochure which lists participating health plans and facilitated enrollers by geographic area who can provide application assistance. This brochure also provides a toll-free hotline that applicants can call for more information on enrollment. The Child Health Plus Hotline is a toll free number which answers inquiries about the CHPlus and Medicaid programs and provides information and assistance to the public regarding eligibility and enrollment in both programs. This hotline provides general program description; income and eligibility requirements; family contribution levels; covered benefits; information on the enrollment process and the names and location of participating health plans. Additionally, this hotline provides application assistance by: answering questions about completing the application; screening callers for eligibility; describing the documentation requirements; and assisting families in locating the LDSS offices or a facilitated enroller for additional application assistance.

Families also have the opportunity to have someone assist them in completing the application and to gather the appropriate documentation required for enrollment. The Department has contracted with 41 community based organizations to provide facilitated enrollment services for the Medicaid, Family Health Plus and CHPlus programs. These organizations are responsible for assisting families in completing the Access NY Health Care application, gathering the necessary documentation and submitting the application to a health plan for enrollment in CHPlus or a LDSS office for enrollment in Family Health Plus and Medicaid.

Applications for CHPlus are sent directly to health plans for eligibility determination. The health plans participating in the CHPlus program are responsible for determining eligibility and enrolling children into the CHPlus program. To do this, the health plan accepts an application from the eligible child or a facilitated enroller and reviews the application for completeness and required documentation. If the application is complete and the child is found eligible for the program, the health plan enrolls the child. If the application is complete but all of the documentation is not present, the child is presumptively enrolled and the health plan would request the applicant to submit missing enrollment documentation within two months. If the family fails to provide documentation, the child's coverage will be terminated at the end of the two month period. Effective September 1, 2007, health plans can no longer enroll the child on a temporary basis except at recertification. If the child appears to be Medicaid eligible, the health plan shall either assist the family in enrolling the child in Medicaid by submitting the application to the LDSS, refer the family to a facilitated enroller to assist in the completion and submission of an application, or refer the family to the local Department of Social Services for eligibility determination.

Each enrollee in the CHPlus program must be re-certified annually. The Department has designed and implemented a simplified application at renewal which collects only information that is necessary to determine continued eligibility for CHPlus coverage and is subject to change since the date of initial application. The family must submit an application to the health plan and any required documentation needed to support the information contained on the application. The health plan will review this information against the eligibility criteria to ensure that the child is still eligible for the program. Health plans may enroll a child at renewal if they continue to appear eligible for CHPlus but the family failed to complete certain sections of the renewal application or failed to provide all documentation. They are given a two-month grace period to provide the missing information. Additionally, families now have the option of documenting their income at renewal by supplying the social security numbers of the household members with countable income. The CHPlus subsidy and coverage shall be terminated or not renewed upon annual re- certification for the following reasons: the child reaches the age of 19; the family's gross income exceeds the eligibility criteria; the child is enrolled in Medicaid; the child no longer resides in the service area of the insurer; and/or the child has other health insurance coverage. Children who "age out" of CHPlus are disenrolled from the health plan on the last day of the month in which they