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Effective Date:

Approval Date:

Updated and amended effective August 24, 2001

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Screening procedures at initial application and at times of renewal ensure that a child will not be enrolled in CHIP if a child is found eligible for Medicaid.

4.4.2. The Medicaid application and enrollment process is initiated and facilitated for children found through the screening to be potentially eligible for medical assistance under the state Medicaid plan under Title XIX. (Section 2102)(b)(3)(B)) (42CFR 457.350(a)(2))

A process known as “Any Form is a Good Form” was adopted in February 1999 which facilitates enrollment in both CHIP and Medicaid. Application documents with a common set of data elements are being utilized to accommodate both the CHIP and Medicaid Program. Application materials for children determined ineligible for Medicaid because family income is within the CHIP range are sent to a CHIP Contractor for a determination of eligibility for CHIP. Application materials for children determined ineligible for CHIP because family income is within the Medicaid range are sent to the appropriate County Assistance Office for a determination of eligibility for Medicaid.

4.4.3. The State is taking steps to assist in the enrollment in SCHIP of children determined ineligible for Medicaid. (Sections 2102(a)(1) and (2) and 2102(c)(2)) (42CFR 431.636(b)(4))

See Section 4.4.2

4.4.4 The insurance provided under the state child health plan does not substitute for coverage under group health plans. Check the appropriate box. (Section 2102)(b)(3)(C)) (42CFR 457.805) (42 CFR 457.810(a)-(c))

4.4.4.1. Coverage provided to children in families at or below 200% FPL: describe the methods of monitoring substitution.

Pennsylvania has taken a number of steps to guard against and monitor for crowd-out. Questions regarding insurance coverage are contained on the application and renewal forms and cross matches against Medicaid and private insurance files are completed to help determine that only uninsured children are enrolled. Data regarding private insurance coverage is collected and reported in the required annual SCHIP report.

Pennsylvania enjoys one of the nation’s highest rates of