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

Effective Date:

Approval Date: 30 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 and receives a new member packet. The eligibility period for Medicaid and CHIP is 12 months

The OHP Central Processing Center conducts standardized audits on an ongoing basis to review eligibility determination to ensure that children who are Medicaid eligible, or have access to a state employee health plan, or have private coverage are not enrolled in CHIP.

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 total of three 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.

In addition, children enrolled in the CHIP program are instructed to notify the program in the event they become pregnant (0-185% of FPL), in which case they will be moved to the Title XIX Poverty Level Medical Program for pregnant women until their eligibility in that category expires. Most children born to women in the Medicaid PLM program are eligible for Medicaid for one year. Before that year is up, we send notification they may be eligible for CHIP when that year is up. The Children who are eligible for CHIP because their household income is between 185-300 % of FPL and who are or become pregnant will remain in CHIP. Babies born to these CHIP children will have assumed eligible newborn status in CHIP for their first year of life. Children above 200% up to and including 300% born into subsidy families do not have assumed eligible newborn status. However, when adding the baby, the worker determines if there would be a decrease in the family's subsidy level, we add the baby for the balance of the existing 12- month eligibility period at the existing subsidy level (i.e., we would