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

Effective Date:

Approval Date: 17 4.1.6.

Disability Status (so long as any standard relating to disability status does not restrict eligibility): Not applicable. 4.1.7.

Access to or coverage under other health coverage: The application form asks for information on the insurance status of children making application. Children with existing health insurance are denied eligibility for Texas SCHIP. Unborn children with existing health insurance are denied eligibility for Texas SCHIP. 4.1.8.

Duration of eligibility: Eligible children receive coverage for 6 continuous months. Eligible unborn children receive coverage for 12 continuous months. 4.1.9.

Other standards (identify and describe): Immigration status: children who are legal residents but have not passed the five year bar are enrolled at the cost of the state.

As referenced in Section 4.3, the state does require the child’s social security number or proof of application for a social security number at the time of application.

4.2. The state assures that it has made the following findings with respect to the eligibility standards in its plan: (Section 2102)(b)(1)(B)) (42CFR 457.320(b))

4.2.1.

These standards do not discriminate on the basis of diagnosis. 4.2.2.

Within a defined group of covered targeted low-income children, these standards do not cover children of higher income families without covering children with a lower family income. 4.2.3.

These standards do not deny eligibility based on a child having a pre-existing medical condition.

4.3. Describe the methods of establishing eligibility and continuing enrollment. (Section 2102)(b)(2)) (42CFR 457.350)

The eligibility process for the Children’s Health Insurance Program is easy to access, convenient for families and is identical to the Children’s Medicaid eligibility process. A single application form is used for Medicaid & SCHIP. Families apply for children’s health insurance by mail, by phone, through a web-assisted application or in person.

The application asks for the following information: • Family’s gross income and the names of employers • Age, names, social security numbers, and insurance status of children • Composition of the family • Resource information • Immigration/Citizenship Status

Information from the application is entered into the SCHIP eligibility system. This entry may occur through several means: data entry by a telephone