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

Effective Date:

Approval Date: 14  Out of pocket costs (including premium) will not exceed the Title XXI cost-sharing cap of five percent. Another component of the overall Oregon Health Plan is the Oregon Medical Insurance Pool (OMIP), Oregon’s high risk health insurance program. The program provides health insurance to Oregon children and their families who have been denied health insurance due to health conditions. OMIP also provides a way to continue coverage for those who exhaust COBRA benefits with no other options. As of May 2009 OMIP serves approximately 15,500 individuals.

The Information, Education, and Outreach program and FHIAP marketing staff connect employers and individual consumers with OPHP-trained agents for help in purchasing a health insurance plan. Agents across the state are trained by staff on the latest state and federal regulatory changes and commercial health insurance reforms, in addition to in- depth information on the programs of the Oregon Health Plan. Marketing staff meet with employers across the state to promote employer partnerships to reduce the overall rate of uninsured in the state.

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)) Oregon conducts the following activities to coordinate the Title V Maternal Child Health Program with OHP-CHIP:

The Child Development and Rehabilitation Center (CDRC) administers the Oregon Services to Children with Special Health Needs (OSCSHN) Title V Program at the Oregon Health and Sciences University (OHSU). The OSCSHN Financial Assistance Program provides financial assistance to families who meet the financial eligibility criteria at three times the federal poverty level and whose child has a qualifying medical diagnosis. Financial counselors screen families to determine program eligibility and make referrals to OHP including Medicaid, CHIP and the Family Health Insurance Assistance Program (FHIAP) when appropriate. OSCSHN staff, conduct follow-up calls to families referred to the OHP to determine the status of applications and to provide assistance when needed. This effort has resulted in more families qualifying for benefits and cost savings to the OSCSHN budget.