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Model Application Template for the State Children's Health Insurance Program

Effective Date: August 24, 2001

Approval Date: 12 The key programs providing creditable coverage for low-income children in South Dakota are the Medicaid and M-SCHIP programs that are jointly administered by the South Dakota Department of Social Services. The interagency agreements identified in Section 2.2.1 on page 8 serve as the referral procedures that the State uses to accomplish the coordination with Title V, WIC and MCH for both the Medicaid and SCHIP programs. The interagency agreements serve to assure the services provided under Title V, WIC, MCH, Title XIX and Title XXI are consistent with the needs of recipients and both the Department of Social Services and the Department of Health’s objectives and requirements to promote high quality health care and services.

There are no other State programs that provide creditable coverage for low-income children. The South Dakota Caring for Children program had existed as a private effort to provide very limited health coverage to low-income children, however operations under that program ceased in 1999. There are no other private programs that offer creditable coverage for low-income children in South Dakota.

The Indian Health Service continues as a provider of creditable coverage to Indian children. The IHS functions as a provider of services and also provides coverage for certain specialty services through their contract health program. Coordination with the IHS will continue in the same way as coordination with the Medicaid program. The IHS will be reimbursed for the direct services they provide to SCHIP children at the same rate of payment as the South Dakota Medicaid program. Since the IHS contract care program is the payer of last resort under Federal Regulations, the SCHIP program will be primary to IHS contract care. Benefit coordination will be accomplished by the IHS denying claims they receive and causing the claims to be submitted to the SCHIP program for payment just as currently happens with Medicaid. Payment for those services under the SCHIP program will be on the same basis as established for the Medicaid program.

The IHS also plays a very important role in the delivery of outreach services to facilitate the identification and enrollment of low-income children for Medicaid and SCHIP. This role will continue for potentially eligible SCHIP children using the established means to interface with the Department of Social Services medical assistance programs.