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

Effective Date:

Approval Date: 18 operator who receives the information through a phone call; data entry by a clerk at a central processing unit who reads the information from the application; or direct data entry via the internet to the extent feasible.

All applicants are screened for Medicaid eligibility before being deemed eligible for SCHIP. Any application in which the family income and resources fall within Medicaid eligibility is routed to a Medicaid worker. Data on that applicant is transferred, electronically and in hard copy, to the Medicaid system. Data on those applicants who are denied Medicaid by Medicaid eligibility staff are transmitted to the SCHIP system and those applicants are notified of their SCHIP eligibility and enrolled in SCHIP health plans.

Applicants applying via the Internet currently print out and sign applications, and mail them with necessary verifications to the central processing unit. Mail-in applications need to include the necessary verifications. In the case of phone applications, the data are printed out and sent to the family with a self-addressed envelope. The family returns the signed application with necessary verifications after reviewing the application for accuracy.

Based on the eligibility information and the receipt of necessary verifications, the system makes a determination of eligibility and sends written notification to the family.

If a child is determined SCHIP eligible, the administrative services contractor sends the family an enrollment packet, which provides information about their health plan choices and any applicable enrollment fee. The family returns to the administrative services contractor the completed enrollment forms and any applicable enrollment fee owed, and the administrative services contractor processes the forms and enrolls the child in a health plan.

For a child’s initial enrollment in SCHIP, a three-month waiting period applies, unless the child qualifies for an exception to the waiting period. Following the waiting period (if applicable), a six month term of coverage begins on the first day of the following month or, if the waiting period does not apply, on the first day of the month following the month in which the enrollment process was completed (by the enrollment processing cut-off date).

Waiting period:

- If the child is found eligible for SCHIP on or before the 15th day of a month, then the waiting period begins on the first day of that same month. - If the child is found eligible on or after the 16th day of a month, then the waiting period begins on the first day of the next month.