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

Effective Date:

Approval Date: 23 provided under the CHIP state plan and families have choice of ESI or HKC option.

4.1.4.

Resources (including any standards relating to spend downs and disposition of resources): No asset limit.

4.1.5.

Residency (so long as residency requirement is not based on length of time in state): Oregon requires a Social Security Number (SSN) for CHIP unless the applicant is a member of religious sect or division of a religious sect that has continuously existed since December 31, 1950 and adheres to its tenets that prohibit applying for or using an SSN.

4.1.6.

Disability Status (so long as any standard relating to disability status does not restrict eligibility): N/A

4.1.7.

Access to or coverage under other health coverage:

The CHIP child must not have been covered by any private major medical health insurance in the past two months before application. The two months of uninsurance are the two months preceding the eligibility determination. This is done at every eligibility review for CHIP, regardless if a new applicant for CHIP, or not. The two-month waiting period is waived if any of the following are true: the person has a condition that without treatment would be life-threatening or cause permanent loss of function or disability; the person’s private health insurance premium was reimbursed under the policy for reimbursement of cost-effective Employer Sponsored Health Insurance; the person’s Insurance premium was subsidized by FHIAP; or the person met the two month uninsurance period while on the FHIAP reservation list even if they have since obtained coverage; a member of the filing group was a victim of domestic violence; or the person lost coverage due to the loss of employment of a parent(e.g.reduction in hours, employer stops providing coverage, etc). Examples of life-threatening or disabling conditions are cancer, asthma, diabetes. Oregon monitors substitution under the Community Human Service’s Quality Control and Quality Assurance process to analyze the extent to which an applicant drops other health