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

Effective Date:

Approval Date: 25 eligibility approval. Enrollment in HKC plans is the first of the month following application approval, if application approval occurs on or before the 25th of the approval month. If application approval is the 26th or after in the approval month, enrollment will be the first of the next month.

Express Lane Eligibility agencies include The Department of Human Services, Supplemental Nutritional Assistance Program (SNAP) and the Department of Education, selected districts, through the National School Lunch Program (NSLP). The Department will use SNAP income findings and apply this income to the child who is applying for medical. The state will use SNAP findings on verification of SSN and state residency. The state will then verify citizenship.

The State Department of Education prepares the application form that all schools use for NSLP Each school district will then send DHS a list of children that are found eligible for free and reduced lunch whose parents did not ‘opt-out’ and who indicated the child does not have any kind of health coverage”. DHS will then send “Express Lane” applications for health coverage to the identified families, requesting additional information. The additional information requested of families includes the names, genders, social security numbers, dates of birth, citizenship status, tribal information, availability of other insurance, disabilities, absent parent information, and managed care information for everyone applying. Applications that are returned will be processed to determine eligibility using regular methodologies including verification of citizenship. The Department will use the NSLP findings for income and household composition for initial eligibility determinations for children. The NSLP will send the Department households’ income and household group size. The Department will send the households shortened applications, and when the applications are returned, the NSLP findings of income and eligibility group size will be used to determine eligibility for children.

The Express Lane option will be applied to initial determinations only.

4.1.10

Check if the State is electing the option under section 214 of the Children’s Health Insurance Program Reauthorization Act of