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Effective Date:

Approval Date:

Updated and amended effective August 24, 2001

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would be put on the waitlist with an effective date of the date when the contractor received a complete enough application to enter into CAPS for an eligibility determination. On a monthly basis, the Commonwealth would make an assessment of the number of enrollees against the appropriated funds for the program. As additional funds would become available (either through attrition of enrollees or more funding is identified) applicants on the waitlist would be notified of the availability of coverage through CHIP. A determination would be made as to the number of new enrollees that could be accommodated with the identified funds. Notifications would go out first to those applicants with the earliest completion date; thus a first come, first served process. To update eligibility, applicants would need to attest that there have not been any changes to their family circumstances (e.g. number in household, income, insurance status, and the like). If changes have occurred, the new information would be added into CAPS and eligibility is re-determined. The signing of the attestation or the submission of additional information would be the basis for a new eligibility date and the 12 months of eligibility would begin with the enrollment. It is not expected that enrollees would be affected by any caps or waiting lists that may be implemented.

4.4. Describe the procedures that assure that:

4.4.1. Through the screening procedures used at intake and follow-up eligibility determination, including any periodic redetermination, that only targeted low-income children who are ineligible for Medicaid or not covered under a group health plan or health insurance coverage (including access to a state health benefits plan) are furnished child health assistance under the state child health plan. (Sections 2102(b)(3)(A) and 2110(b)(2)(B)) (42 CFR 457.310(b) (42CFR 457.350(a)(1)) 457.80(c)(3))

Families declare on the application form whether their children are receiving Medicaid or some other form of health insurance coverage. Only those children without another source of creditable coverage are enrolled in CHIP. CHIP contractors compare applicants’ names against their commercial subscribers to determine if they have health insurance coverage through their companies. Matches are also conducted against Medicaid Client Information (CIS) files to determine if a child is already enrolled in Medicaid. With the CHIP expansion, we will include a match of all new applications against the Department of Public Welfare’s Third Party Liability database to assist in the determination that applicants do not have creditable private insurance and meet the state’s required period of uninsurance. We will also run a full enrollment match on a minimum of a quarterly basis to verify that enrollees have not picked up private insurance during the enrollment period. The combination of these efforts gives a high degree of assurance that coverage is received only by those without another source of coverage.