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

Effective Date:

Approval Date: 2-3

2.2.2. The steps the state is currently taking to identify and enroll all uncovered children who are eligible to participate in health insurance programs that involve a public-private partnership:

Not applicable.

2.3. Describe the procedures the state uses to accomplish coordination of CHIP with other public and private health insurance programs, sources of health benefits coverage for children, and relevant child health programs, such as title V, that provide health care services for low-income children to increase the number of children with creditable health coverage. (Previously 4.4.5.) (Section 2102)(a)(3) and 2102(c)(2) and 2102(b)(3)(E)) (42CFR 457.80(c))

In order to increase coverage for uninsured children in New York State, New York coordinates the enrollment of children in its current CHPlus and Medicaid programs. Families apply for health insurance for their children on one application. They are screened for Medicaid and if found eligible, are enrolled in that program. The Department developed a common application for individuals and families to apply for Family Health Plus, Medicaid and CHPlus. This application is called the Access NY Health Care (Access NY) application.

The Department of Health has reorganized such that the Medicaid and Child Health Plus programs are co-located in the newly created Office of Health Insurance Programs (OHIP). The Division of Coverage and Enrollment within OHIP is responsible for establishing the enrollment policy for Medicaid, Family Health Plus, and Child Health Plus. It ensures that the rules for each program are developed rationally and are clearly disseminated to program partners including local districts, health plans, and facilitated enrollers.

Under the CHPlus program, through the purchase of a managed care insurance product, children have primary care providers who coordinate their health care, including referrals to specialists when appropriate. Whenever possible, CHPlus providers are also Medicaid providers. Children who enroll in Medicaid or CHPlus may experience changes which make them ineligible for one program and eligible for the other. Thus, having most health plans participating in CHPlus program and also participating in Medicaid will allow children the ability to move between insurance programs without changing providers.

New York’s CHPlus program also coordinates with the WIC program, a program to improve the nutrition and health of women, infants and children. Applicants to the CHPlus program can also apply to WIC using the Access NY Health Care application.

Coordination with the Title V program also exists. CHPlus staff works with Department staff responsible for Title V programs and with the Child Health Services Block Grant Advisory Council on programmatic issues. Many Title V grantees are facilitated enrollers assisting families in completing applications for health insurance. On the local level, many Title V programs promote CHPlus to their clients and communities. For example:

• Healthy Child Care New York distributes CHPlus materials such as posters and brochures to the child care community in collaboration with the Office of Children and Family Services. The training for child care health consultants, which is done by Title V staff,