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

Effective Date: August 24, 2001

Approval Date: 21

The Department will monitor whether or not coverage under SCHIP is substituting for coverage under group health plans by conducting survey random surveys. The surveys contain questions relating to insurance coverage, and specifically asks questions in order that ‘crowd out’ can be measured. In addition to the department’s random survey, the South Dakota Department of Health conducts a Behavioral Risk Factor Surveillance Survey (BRFSS), as described in Section 9.3, that asks specific questions regarding the dropping of private health insurance for public assistance programs. The responses of both surveys are computed, documented and are included in the SCHIP annual report to measure the affect of crowd- out.

The State also monitors the number of SCHIP applicants who are denied eligibility due to substituting coverage under group health plans within 3 months prior to application. Additionally, the State monitors the number of SCHIP applicants who are denied or closed due to existing health insurance. This information is captured in a reporting mechanism that is also included in the SCHIP annual report to measure whether recipients are trying to substitute private health insurance for public assistance.

4.4.4.2. Γ Coverage provided to children in families over 200% and up to 250% FPL: describe how substitution is monitored and identify specific strategies to limit substitution if levels become unacceptable.

4.4.4.3. Γ Coverage provided to children in families above 250% FPL: describe how substitution is monitored and identify specific strategies in place to prevent substitution.

4.4.4.4. Γ If the state provides coverage under a premium assistance program, describe:

The minimum period without coverage under a group health plan, including any allowable exceptions to the waiting period.

The minimum employer contribution.