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

Effective Date:

Approval Date: 29 FHIAPs biennial budget. Enrollment would be allowed to reduce by attrition methods or close to new applicants. Children in families with income from zero up to and including 200 percent of the FPL currently on the FHIAP Reservation List: The State will perform targeted outreach to families on the existing reservation list to ensure they are aware that children also have the option to receive direct state plan coverage at any time under Medicaid or CHIP. Families with children will be sent information about direct coverage through Healthy Kids, along with a Healthy Kids application, and a letter encouraging families to apply for immediate coverage rather than wait on FHIAP’s reservation list. Families must either complete the application or actively decline direct coverage. All children that choose FHIAP at the point of application and choose to go on the reservation list will also receive information on direct coverage options and be informed that they can move from the FHIAP reservation list or decline CHIP or Medicaid coverage, but still be given the opportunity to choose to move to direct state plan coverage at any time.

4.4. Describe the procedures that assure that:

4.4.1. Through the screening procedures used at intake and follow-up eligibility determination, including any periodic redetermination, that only targeted low-income children who are ineligible for Medicaid or not covered under a group health plan or health insurance coverage (including a state health benefits plan) are furnished child health assistance under the state child health plan. (Section 2102)(b)(3)(A)) (42CFR 457.350(a)(1) and 457.80(c)(3))

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 FQHC, Tribal health clinics, DSH hospitals, Healthy Start, local health departments and Certified Application Assistance Organizations, Outreach Grant Organizations and DHS branch offices. Potential clients that submit an application over the internet must affirm that the information supplied is true under penalty or 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