CHIP and TP 43, TP 44 and TP 48

When taking action on an application, the following procedures must be applied:

If ... then ... The child applying is not active in CHIP or pending CHIP enrollment, test for Medicaid eligibility. Follow the policy for assigning the MED*. The child applying is active in CHIP and the CHIP end date is the application month or the following month, test for Medicaid eligibility. If eligible, and it is: before cutoff, begin Medicaid coverage the first day of the next month. after cutoff, begin Medicaid coverage the first day of the month following the next month. The child applying is active in CHIP and the CHIP end date is later than the month following the application month, test for Medicaid eligibility. If eligible, and processing is: before cutoff, begin Medicaid coverage the first day of the next month. after cutoff, begin Medicaid coverage the first day of the month following the next month. The child applying is pending CHIP enrollment with a start date the first day of the next month, test for Medicaid eligibility for the three months prior, if the application indicates unpaid medical bills. Test for ongoing Medicaid eligibility. If eligible, and it is: before cutoff, follow the policy for assigning the MED. after cutoff, begin Medicaid coverage the first day of the month following the next month. Provide open/close coverage for the application month and/or prior months, if applicable. The child applying is pending CHIP enrollment with a start date later than the first day of the next month, test for Medicaid eligibility for the three months prior, if the application indicates unpaid medical bills. Test for ongoing Medicaid eligibility. Follow the policy for assigning the MED. The child is active in CHIP, the application indicates she is pregnant, and the CHIP end date is in the application month, test for Medicaid eligibility. If eligible, begin Medicaid coverage the first day of the month following the CHIP end date. The child is active in CHIP, the application indicates she is pregnant, and the CHIP end date is in the month following the application month or later, test for Medicaid eligibility. If eligible, and it is: before cutoff, begin Medicaid coverage the first day of the next month. after cutoff, begin Medicaid coverage the first day of the month following the next month. One child in the family applying is active in CHIP and another is not, test for Medicaid eligibility. If eligible, follow the applicable guidelines given in the preceding scenarios, for each child. * See A-820 , Regular Medicaid Coverage, to apply the MED.

After determining a child is ineligible for Medicaid, TIERS will test eligibility for CHIP.

When the head of household does not provide their date of birth (DOB) and/or Social Security number (SSN), the following steps are taken to obtain the information:

Call the household to try to obtain the correct DOB and/or SSN. Let the household know this information is voluntary and is not required to make an eligibility determination for the child; however, it will help expedite the process.

If unable to obtain the DOB and/or SSN by telephone, continue to process the child's application for Medicaid.

Select a random DOB for the caretaker/second parent, with a year between 1965 and 1975. Using randomly selected DOBs reduces or eliminates the problem of duplicate individual numbers.

The SSN field is left blank if the correct number is not available.

Staff ensure that all other demographic information is correct and include the individual's middle name, when available.