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Effective Date:

Approval Date:

Updated and amended effective August 24, 2001

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developed by the Department for the purpose of determining eligibility for CHIP and adultBasic. Applications for enrollment and re-enrollment are received via: the internet through the Commonwealth of Pennsylvania’s Access to Social Services (COMPASS); telephone through calls to the Health and Human Services Helpline; through referrals from the Medicaid agency; or, a mail-in process. Data matches with other agencies, health insurance carriers and employers are conducted after an application is entered into CAPS and prior to a final determination of eligibility. Contractors enroll children on a prospective basis on the first of each month. Contractors are provided with the CHIP Procedures Manual and other forms of instruction (i.e. CHIP Transmittals) which prescribe the method and procedures to be used in the determination of eligibility. Parts I and II of the manual prescribe:

• Basic eligibility requirements relating to income, age, residency, citizenship, and the lawful status of non-citizens • Verification requirements (required for income only unless, in the judgment of the contractor, other verification is needed to clarify incomplete or inconsistent information provided on the application) • Application processing standards (a decision on eligibility or ineligibility must be made within fifteen calendar days from the receipt of a complete application) • Notification requirements for notices of eligibility, ineligibility, renewal and termination

4.3.1. Describe the state’s policies governing enrollment caps and waiting lists (if any). (Section 2106(b)(7)) (42CFR 457.305(b))

Check here if this section does not apply to your state.

The Commonwealth would closely monitor expenditures of SCHIP funds. If necessary and feasible, we would cap the number of new enrollees in the expanded population (those above 200% of the FPL) and create a waiting list for that population to ensure we do not exceed our SCHIP allotment for the year. Prior to implementing a cap and waiting list, the state will provide CMS with appropriate notifications. Other actions at time of decision include: • Publication in the Pennsylvania Bulletin 60 days prior as public notification • Include waiting list information on CHIP and COMPASS web sites

New applications would still be accepted through the normal processes. Screen and enroll procedures for Medicaid would remain unchanged. Eligibility would be run on all applications. The applications of individuals that appear to be eligible for Medicaid would be forwarded to the Department of Public Welfare for eligibility determination. Those applicants not eligible for Medicaid