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

Effective Date:

Approval Date: 2-2

INSURED Family Income as % of FPL Region Race/Ethnicity White Non-Hispanic

Black Non-Hispanic

Hispanic

Other, d.k.

All 000-099% NYC 71,346 207,308 238,983 50,119 567,756

ROS 202,803 63,997 70,308 29,527 366,634

All 274,149 271,305 309,291 79,646 934,390

100-249% NYC 103,263 132,882 212,177 75,105 523,427

ROS 378,835 75,797 94,761 31,839 581,234

All 482,098 208,679 306,938 106,944 1,104,661

250%+ NYC 337,941 194,269 142,565 93,566 768,341

ROS 1,299,572 83,000 122,867 92,071 1,597,509

All 1,637,513 277,269 265,432 185,637 2,365,850

All NYC 512,550 534,459 593,725 218,790 1,859,524

ROS 1,881,210 2,22,794 287,936 153,437 2,545,377

All 2,393,760 757,253 881,661 372,227 4,404,901

2.2. Describe the current state efforts to provide or obtain creditable health coverage for uncovered children by addressing: (Section 2102)(a)(2) (42CFR 457.80(b))

2.2.1. The steps the state is currently taking to identify and enroll all uncovered children who are eligible to participate in public health insurance programs (i.e., Medicaid and state-only child health insurance):

New York State actively pursues all uninsured children in the State through a multifaceted outreach campaign and a simplified enrollment process. The Connections to Coverage Campaign, the Department’s outreach campaign, is used to identify and assist in enrolling uninsured children into the Child Health Plus and Medicaid programs. Campaign strategies include developing community partnerships, conducting outreach at community events, training community partners about public health insurance and raising public awareness of the programs through distribution of health education materials. Health plans participating in the program also advertise the CHPlus program to solicit enrollment into their plans. Community based facilitated enrollment agencies also reach out to the uninsured to encourage them to apply for health insurance.

Once families learn of the program, the program is geared to help the families enroll their children as easily as possible. Families can enroll their children by applying through the mail, at the health plan of their choice or through a community based organization (CBO).