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

Effective Date: August 24, 2001

Approval Date: 18 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))

The application form for SCHIP medical assistance in South Dakota also is used for the Medicaid program. Verifications of income and income deductions must be provided with the application. Information on the insurance status of individuals requesting assistance is required on the application form. Clients completing the form do not have a choice for a particular program of medical assistance. Department of Social Services caseworkers determine eligibility for each of the States’ medical assistance programs, Medicaid, M-SCHIP and CHIP-NM and make the decisions on which program is providing coverage.

Caseworkers use statewide procedures and a uniform, statewide eligibility database. Automated editing of intake data provides assistance to the caseworkers. The statewide database allows caseworkers to do follow up screening on applications to access eligibility information from other DSS programs, IEVS verifications, and an individual’s prior eligibility history. Insurance information including type of coverage, name and address of carrier, policy numbers and dates of coverage are part of the automated database maintained by the department for third party liability and eligibility purposes.

The caseworker will decide the appropriate category or program of coverage for the children depending on income and insurance status as follows: • Uninsured children birth to age 19 from families with incomes from over 140% to 200% of the FPL will receive CHIP-NM; • Uninsured children age 6 through 18 from families with incomes from over 100% of FPL to 140% of FPL will receive M-SCHIP; • Uninsured children under age 6 from families with incomes from over 133% to 140% of FPL will receive M-SCHIP;