Page 22

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

Effective Date: August 24, 2001

Approval Date: 22 The cost-effectiveness determination.

4.4..5 Child health assistance is provided to targeted low-income children in the state who are American Indian and Alaska Native. (Section 2102)(b)(3)(D)) (42 CFR 457.125(a))

SCHIP is available to all targeted low-income Indian children in South Dakota regardless of tribal membership, enrollment, or affiliation. Inasmuch as the program is a statewide program, SCHIP is also made available to children living on Indian reservations within the State’s borders. Indian children not living on reservations are also potentially eligible for SCHIP coverage. The availability of services through the Indian Health Service is not considered insurance for the Medicaid, M-SCHIP or CHIP-NM program.

To help assure SCHIP is provided to Indian eligible children the Department has outreach efforts directed towards the Indian reservation areas of the state. The Indian Health Services currently plays and will continue to play a very important outreach role for targeted, low- income Indian children. Applications, enrollment assistance, and program information for SCHIP is available at IHS, Tribal, and Urban Indian Health locations in South Dakota.

SCHIP services will be provided to Indian children in the state eligible to receive services from the Indian Health Service as the Indian Health Service facilities and providers are enrolled as health care providers for the SCHIP program and eligible for reimbursement for services provided to SCHIP children. Tribal clinics and other providers are also eligible for reimbursement for covered services under SCHIP as are Urban Indian Health clinics.

Section 5. Outreach (Section 2102(c))

Describe the procedures used by the state to accomplish:

Outreach to families of children likely to be eligible for child health assistance or other public or private health coverage to inform them of the availability of the programs, and to assist them in enrolling their children in such a program: (Section 2102(c)(1)) (42CFR 457.90)

The CHIP-NM program built on the existing programs of coverage for low income,