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

Effective Date:

Approval Date: 37 disabilities or chemical dependency; and those experiencing homelessness.

The criteria used to award an outreach and enrollment grant are: (1) Ability to Target geographic areas with high rates of eligible but unenrolled children, including rural areas; racial, ethnic and language minority communities and populations with additional barriers to accessing health care, such as those with physical, cognitive, sensory or mental disabilities or chemical dependency and those experiencing homelessness; (2) Demonstrate that they have access to, and credibility with, target populations; and (3) Demonstrate that they have the ability to address barriers to enrollment, such as a lack of awareness, stigma concerns and punitive fears or cultural barriers. (4) Are not currently a CAAO participating in the AAP.

Outreach and Enrollment Grants will begin effective upon CMS approval on or after October 1, 2009. The grant will be for the balance of state fiscal year 2010 and renewable for a second year, based on performance. Grants will range from $20,000 to $80,000 a year. We anticipate awarding approximately 20 to 40 grants in the first biennium. Each grantee will have enrollment targets that they have proposed in their application and will have been approved by Office of Healthy Kids. Grantees will be required to provide monthly reports on their progress. Fund disbursement will be contingent upon demonstrating progress toward their goals. The Office of Healthy Kids will be fully staffed with at least one FTE monitoring their progress and providing technical assistance.

Outreach and Enrollment Grant agreement statement of work includes, but is not limited to: Identifying its target population(s); • Distributing DHS-approved promotional, educational and marketing materials to its targeted population • Completing application assistance training, provided by DHS; • Participating in meetings and conferences as requested by DHS; • Assisting its targeted population in completing the enrollment process into the Healthy Kids program, in accordance with the application assistance training; • Collaborating with local community organizations and establishing information-sharing processes as needed. • Submitting its progress to DHS on monthly and annual basis according to reporting requirements specified by DHS, including the number of families contacted and the number of children enrolled successfully;