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Effective Date:

Approval Date:

Updated and amended effective August 24, 2001

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Section 4. Eligibility Standards and Methodology. (Section 2102(b))

Check here if the state elects to use funds provided under Title XXI only to provide expanded eligibility under the state’s Medicaid plan, and continue on to Section 5.

4.1. The following standards may be used to determine eligibility of targeted low- income children for child health assistance under the plan. Please note whether any of the following standards are used and check all that apply. If applicable, describe the criteria that will be used to apply the standard. (Section 2102)(b)(1)(A)) (42CFR 457.305(a) and 457.320(a))

4.1.1.

Geographic area served by the Plan: 4.1.2.

Age: CHIP provides free coverage to children from birth though 18. (see Appendix A, the Act , section 2311 (D)) 4.1.3.

Income: CHIP provides free coverage to children in families with net income at or under 200% of FPL. Subsidized CHIP will be provided to children in families with net income of greater than 200% of FPL, but not greater than 300% of FPL. “Net” income is determined by subtracting from gross earnings:

• a work deduction for each employed family member whose income must be counted in determining eligibility ($120 monthly/$1440 annually).

• day care expense incurred up to $200 monthly/$2400 annually for a child under age two; up to $175 monthly/$2100 annually for a child over the age of two or for a disabled adult.

After income disregards above are applied and net income is determined for eligibility and cost sharing purposes, all income above 200% up to 300% FPL is disregarded

4.1.4.

Resources (including any standards relating to spend downs and disposition of resources): 4.1.5.

Residency (so long as residency requirement is not based on length of time in state): 4.1.6.

Disability Status (so long as any standard relating to disability status does not restrict eligibility): 4.1.7.

Access to or coverage under other health coverage: Pennsylvania requires that children be totally uninsured or ineligible for Medicaid to be eligible for CHIP. Contractors have the capacity to compare enrollee families to their own company subscribers to verify whether the family has private or employer