Page 19

4.4.4.2

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.

The CoverKids application form will request information regarding other insurance coverage for each child. The TPA will not enroll any child that has creditable employer-based group health coverage or any child whose family has dropped coverage in the previous three months, unless due to reasons such as layoff, business closing, or similar circumstance that resulted in the involuntary loss of previous insurance. The fact that employer-based group health coverage was dropped will be documented and there is a 3- month waiting period to apply for CoverKids if the child’s family has dropped employer-based group health coverage unless the exception criteria are met.

The State will monitor substitution through information that is gathered during the application process and through surveys of families. The TPA will collect information about whether children have had coverage in the past three months and the reason for dropping that coverage as part of the application process. This data will be utilized to analyze the extent of substitution. In addition, the evaluation contractor will conduct surveys of families with children enrolled in CoverKids. Those surveys will include information on past coverage and the reasons that the child lost that coverage. The evaluation contractor will analyze that data and that analysis will be included in the annual reports to CMS. If substitution levels are found to be unacceptable, the State will consider increasing the waiting period or instituting other actions to reduce the occurrence of crowd out.

4.4.4.3

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

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

The minimum period without coverage under a group

19