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

Effective Date:

Approval Date: 4-9 CHPlus, all rules, policies and procedures applicable to CHPlus enrollees become applicable to that child.

4.4.4 The insurance provided under the State Child Health Plan does not substitute for coverage under group health plans. Check the appropriate box. (Section 2102)(b)(3)(C)) (42CFR 457.805) (42 CFR 457.810(a)- (c))

4.4.4.1. Coverage provided to children in families at or below 200% of the FPL: describe the methods of monitoring substitution.

4.4.4.2. Coverage provided to children in families over 200% and up to 250% of the FPL. Describe how substitution is monitored and identify specific strategies to limit substitution if levels become unacceptable.

An evaluation of the CHPlus program has shown that “crowd-out” has not been an issue. The most recent data shows that approximately 2 percent of our new enrollees have dropped insurance from group health plans to enroll in CHPlus. This number is significantly lower than the number we monitor against.

The State monitors prior insurance of applicants to ensure that the program does not substitute for coverage under group health plans. The Access NY application used by the State to enroll children asks if the applicant currently has insurance or if they have had coverage within the past six (6) months. If they currently have health coverage, they are not eligible for the program. If they had health coverage, they are questioned if it was through their employer and the reason they no longer have health insurance through their employer. The State collects the information on prior health insurance status quarterly from the health plans. This information is analyzed to determine the percentage of new enrollees who have dropped employer-based health insurance for enrollment in CHPlus. If the percentage reaches an average of eight (8) percent for the last three (3) quarters, a six- month waiting period will be imposed. The responsible adult filling out an application must attest to the source and nature of any health care coverage the child is receiving or has received in the past six months.

4.4.4.3. Coverage provided to children in families above 250% of the FPL. Describe how substitution is monitored and identify specific strategies in place to prevent substitution.

Children whose gross family income is between 251% and 400% of the federal poverty level (as defined and updated by the United States Department of Health and Human Services) cannot have had a private employer-based health insurance coverage during the past six months unless such coverage was dropped due to the following: