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Effective Date:

Approval Date:

Updated and amended effective August 24, 2001

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sponsored coverage. We currently match new applications against a Medicaid data base to ensure the applicants are not already enrolled in Medicaid. Effective with the implementation of state plan amendment, the Commonwealth will also run a match through a Third Party Liability contract to assist in the determination that the applicants do not currently have private insurance and that the required period of uninsurance has been met.

4.1.8.

Duration of eligibility: Children are guaranteed a minimum of 12 months coverage and are recertified on their anniversary date.

4.1.9.

Other standards (identify and describe):

• A child must be a citizen of the United States, a U.S. national, or a qualified alien, consistent with SCHIP regulations defined at 42 CFR 457.320(b)(6).

• Children over the age of 2 whose family’s net income is greater than 200% of FPL will be subject to a period of uninsurance. The period of uninsurance is defined as six months prior to enrollment, except as specified in 4.4.4.2.

• To facilitate cross matches between information technology systems, Social Security numbers will be requested on applications. If an applicant does not yet have a social security number, the insurance contractor will conduct outreach to the applicant to obtain the number. An application will not be delayed nor denied due to the absence of the Social Security number.

4.2. The state assures that it has made the following findings with respect to the eligibility standards in its plan: (Section 2102)(b)(1)(B)) (42CFR 457.320(b))

4.2.1.

These standards do not discriminate on the basis of diagnosis. 4.2.2.

Within a defined group of covered targeted low-income children, these standards do not cover children of higher income families without covering children with a lower family income. 4.2.3.

These standards do not deny eligibility based on a child having a pre-existing medical condition.

4.3. Describe the methods of establishing eligibility and continuing enrollment. (Section 2102)(b)(2)) (42CFR 457.350)

CHIP Contractors enter application data into the Commonwealth’s CHIP and adultBasic Processing System (CAPS). CAPS is the automated system