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

Effective Date:

Approval Date: 32 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 and receives a new member packet. The eligibility period for Medicaid and CHIP is 12 months.

In an effort to maximize enrollment of CHIP children the Application Assistance Program (AAP). Certified Application Assistance Organizations (CAAO) will provide application assistance to potential CHIP eligibles. An organization is certified as a CAAO if they are doing business in the state of Oregon and registered with the Secretary of State. Upon completion of an application with DHS and signing an agreement to use trained application assisters and conduct criminal background checks on application assisters the entity is certified as a CAAO. Oregon will not limit the number of organizations that are certified as a CAAO. Organizations, existing or new may not participate in both the AAP and Outreach and Enrollment grant programs. Organizations that provide medical services are not eligible to be CAAO certified, these include clinics, hospitals, FQHCs, MCO or Public health departments. These non certified CAAO organizations are currently in a program which allows them to use a “date stamp” in order to establish a date of request for client’s presenting themselves for medical care. We do not provide compensation to these providers.

4.4.4 The insurance provided under the state child health plan does not substitute for coverage under group health plans. Check the appropriate box. (Section 2102)(b)(3)(C)) (42CFR 457.805) (42 CFR 457.810(a)-(c))

4.4.4.1. Coverage provided to children in families at or below 200% FPL: describe the methods of monitoring substitution. DHS has specific measures to prevent the clients from substituting CHIP