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

Effective Date:

Approval Date: 16 Section 4. Eligibility Standards and Methodology. (Section 2102(b))

Check here if the state elects to use funds provided under Title XXI only to provide expanded eligibility under the states Medicaid plan, and continue on to Section 5.

4.1. The following standards may be used to determine eligibility of targeted low- income children for child health assistance under the plan. Please note whether any of the following standards are used and check all that apply. If applicable, describe the criteria that will be used to apply the standard. (Section 2102)(b)(1)(A)) (42CFR 457.305(a) and 457.320(a)) These standards are be used for Texas SCHIP: 4.1.1.

Geographic area served by the Plan: Eligible children throughout the state will receive services. 4.1.2.

Age: Children through the age of 18 years will be eligible.

4.1.2.1

Age: For unborn children, coverage can begin from the confirmation of pregnancy and enrollment in CHIP Perinatal Program.

4.1.3.

Income: Children whose gross family income is at or below 200% of the federal poverty level (FPL) will be eligible. 4.1.4.

Resources (including any standards relating to spend downs and disposition of resources): Family resources are not taken into account in the determination of eligibility for children at or below 150% of the federal poverty level.

For children with gross family income above 150% of the federal poverty level, a family resource test is applied. For these families, the resource limit will be $5,000 or less in countable liquid resources, combined with excess vehicle value. Up to $15,000 of the fair market value of the family’s highest valued vehicle will be exempted. For other countable vehicles, fair market value in excess of $4,650 will be counted. Certain types of vehicles, such as income producing vehicles will be exempted.

Additionally, family resources are evaluated as part of the screening and enrollment process for Medicaid eligibility.

Unborn children to be delivered to families with income at or below 200% of the federal poverty level are exempt from family resource test requirements for eligibility determination.

4.1.5.

Residency (so long as residency requirement is not based on length of time in state): Children must be residents of Texas to be eligible for services.