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

Effective Date: August 24, 2001

Approval Date: 17 must be included with the application. The application form also contains a simplified financial work sheet to assist potentially eligible persons make an estimate of their income, relative to the eligibility guidelines to assist them in making a decision to apply for benefits.

Department of Social Services caseworkers will make the eligibility determinations based on the information reported on the applications, other information available to the department, and Department regulations and policies. The Department will make decisions within 45 days of the receipt of the application with written notification of the result directly to the applicant parent or head of household.

Upon approval, families will be notified of the eligible children, receive an information packet including information on covered services, the primary care case management program, EPSDT benefits, and other important information. This information includes a description of the scope and duration of covered benefits, and access to emergency services. Clients are also notified of the need to choose a primary care provider and given a listing of the provider’s names and locations in their area. Clients are also notified of their rights to appeal and grievance processes, non-discrimination, and the confidentiality of client/patient information. SCHIP beneficiaries receive the same beneficiary information and protections as beneficiaries of the Medicaid program as both are delivered by the Department of Social Services.

Ongoing eligibility is monitored by requiring families to report changes that might affect their eligibility when they occur. The reporting procedures and forms for reporting changes under SCHIP are the same as those used for Medicaid.

Annual redeterminations are completed after 12 months of eligibility. The Department, during the 11th month of eligibility, initiates the redetermination process by mailing a redetermination packet to families. The information required and the redetermination process is very similar to the initial enrollment process. The redetermination process is completed prior to the end of the original eligibility period so families receive timely notice and there is no break in coverage if eligibility continues. Eligibility for Medicaid, and SCHIP will be reviewed during the redetermination process and the children enrolled in the appropriate coverage program. Children who had been eligible for SCHIP will have Medicaid eligibility reviewed at redetermination, and if Medicaid eligible, will be enrolled in the Medicaid program.

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

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