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

Effective Date:

Approval Date: 17 required to enroll in a DCO and can receive dental services on a FFS basis from any dentist enrolled with DMAP who will accept their CHIP insurance. The problem of dental care capacity in Oregon, and particularly pediatric dental capacity, is not unique to Oregon Medicaid. There is overall an insufficient supply of pediatric dentists in the state. DMAP continues to work in coordination with the Oregon Dental Association and Dental coalitions to develop strategies to encourage more dentists to practice in Oregon.

FHIAP Program:

The Office of Private Health Partnerships (OPHP) administers FHIAP; a premium assistance program for families from zero up to and including 200 percent FPL who are enrolled in ESI or Individual private market health plans. FHIAP provides subsidies to program participants to purchase Employer Sponsored Insurance Plans (ESI) or individual market plans. Insurance plans approved for subsidy must meet benefit benchmark standards.

Healthy Kids ESI: OPHP also administers Healthy Kids ESI; a private insurance option available to children in families who have employer-sponsored insurance available to them. Healthy Kids ESI subsidies are available to children in families from zero up to and including 300 percent of the FPL. HK ESI plans must meet the same benchmark standards as FHIAP plans.

The benchmark for FHIAP and Healthy Kids ESI plans is approved at a level actuarially equivalent to federally mandated Medicaid benefits (as outlined in CMS approval letter, #21-W-00013/10 and 11-W-00160/10). FHIAP requires all eligible children of enrolled families insured, in order for adults to receive assistance. All eligible children in the household must be insured through public or private coverage first, and the coverage must be maintained as long as the family is enrolled. FHIAP and Healthy Kids ESI carriers are licensed and regulated by the Oregon Insurance Division. They must adhere to rules and regulations specific to commercial insurers, the plans offered by these carriers must meet the benchmark requirement. The benefits must meet a federally- approved benchmark (as outlined in CMS approval letter (#21-W- 00013/10 and 11-W-00160/10). FHIAP and Healthy Kids ESI is a “qualifying event”, so members generally have an opportunity to enroll in their health plan immediately, without waiting for open enrollment. Eligible members also have the opportunity to enroll in OHP-Plus if they