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

Effective Date:

Approval Date: 28 4.3. Describe the methods of establishing eligibility and continuing enrollment. (Section 2102)(b)(2)) (42CFR 457.350) Oregon uses one application for CHIP and Medicaid. This application is obtained by calling the toll free application hotline number that provides application assistance and sends applications to people requesting applications. Applications may also be obtained and submitted on line via the internet, through outreach locations at FQHCs, Tribal health clinics, DSH hospitals, Healthy Start, local health departments and Certified Application Assistance Organizations, Outreach Grant Organizations and DHS branch. Potential clients that submit an application over the Internet must affirm that the information supplied is true under penalty of perjury. Applicants are informed of the Medicaid and CHIP program in the application packet. The applicant sends the application to the OHP Central Processing Center. Eligibility workers first screen the application to determine if the child is eligible for OHP Medicaid, using the initial gross income test standard and applicable resource standards. If the child is over income for OHP Medicaid, the application is then screened for CHIP eligibility. The same eligibility workers conduct this eligibility determination process, thus coordinating and streamlining the procedures. Once eligibility has been established, the applicant is notified of eligibility and they receive a new member packet. The eligibility period for all children, Medicaid and CHIP is 12 months.

To facilitate continuous health care coverage for eligible children, the OHP application processing center sends a notice and a new simplified redetermination form to enrollees notifying them that their coverage is scheduled to end soon. Enrollees receive a reapplication packet and two additional notices before coverage is terminated. However, the recipient does not need to complete a new application; they can contact their worker or local branch and establish a request for medical assistance. Once they have initiated a new date of request, an eligibility worker must review the recipient's eligibility and request verification necessary for the new eligibility determination.

4.3.1 Describe the state’s policies governing enrollment caps and waiting lists (if any). (Section 2106(b)(7)) (42CFR 457.305(b))

Check here if this section does not apply to your state. Oregon’s OHP Plus CHIP program and Healthy KidsConnect does not currently have an enrollment cap. The children opting for the FHIAP ‘premium assistance’ program may have enrollment limited if enrollment numbers exceed