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4.4.2 The Medicaid application and enrollment process is initiated and facilitated for children found through the screening to be potentially eligible for medical assistance under the state Medicaid plan under Title XIX. (Section 2102)(b)(3)(B)) (42CFR 457.350(a)(2))

When a child appears to be eligible for either TennCare Medicaid or TennCare Standard as determined by the CoverKids TPA, the TPA will notify the family, provide the family with a TennCare application, and offer assistance in completing the application. The TPA (or the family at their option) will send the completed TennCare application to the appropriate Department of Human Services (DHS) office for a determination of TennCare eligibility. The child will not be enrolled in the CoverKids program and the application will be suspended pending a determination by DHS. If DHS ultimately determines the child to be ineligible for TennCare, they will notify the CoverKids TPA and CoverKids eligibility will be automatic based on the TPA’s updating of the original application with information provided by TennCare. The TPA will have look-up access to the DHS eligibility and enrollment system to assure that applicants are not already covered by TennCare Medicaid or TennCare Standard.

4.4.3 The State is taking steps to assist in the enrollment in SCHIP of children determined ineligible for Medicaid. (Sections 2102(a)(1) and (2) and 2102(c)(2)) (42CFR 431.636(b)(4))

When a child is determined ineligible for TennCare Medicaid or TennCare Standard and potentially eligible for CoverKids, DHS will forward the TennCare application to the CoverKids TPA. The TPA staff will enter relevant information from DHS into their system and award coverage beginning on the first day of the month following receipt of the application from TennCare. For applications processed within five work days of the beginning of the next month, coverage will begin the first day of the following month.

4.4.4 The insurance provided under the state child health plan does not substitute for coverage under group health plans. Check the appropriate box. (Section 2102)(b)(3)(C)) (42CFR 457.805) (42 CFR 457.810(a)-(c))

4.4.4.1

Coverage provided to children in families at or below 200% FPL: describe the methods of monitoring substitution.

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