Page 21

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

Effective Date:

Approval Date: 21 Texas has two “state health benefits” plans: state employee health coverage under the state Employee Retirement System (ERS) and health coverage for active school district employees available through the Teachers Retirement System (TRS “Active Care”). State law treats these two groups differently, but children with access to either benefits plan are not eligible for SCHIP federal funding.

Children with access to TRS Active Care may be enrolled in Texas SCHIP program, but are identified and paid as state-funded members. Information about the availability of employer-based insurance and the employer name is obtained during the application process. Additionally, electronic data matching is performed with both the ERS and TRS systems to identify children with access to those benefits.

4.4.2. The Medicaid application and enrollment process is initiated and facilitated for children found through the screening to be potentially eligible for medical assistance under the state Medicaid plan under Title XIX. (Section 2102)(b)(3)(B)) (42CFR 457.350(a)(2))

As described in Section 4.4.2 above, Medicaid workers complete the enrollment of these children into the program. The state tracks applications of children who are deemed Medicaid eligible to determine whether eligible applicants choose to enroll.

4.4.3. The State is taking steps to assist in the enrollment in SCHIP of children determined ineligible for Medicaid. (Sections 2102(a)(1) and (2) and 2102(c)(2)) (42CFR 431.636(b)(4))

Children determined ineligible for Medicaid are automatically enrolled in SCHIP based on electronic data sharing between the Medicaid eligibility agency and the SCHIP administrative services contractor.

4.4.4 The insurance provided under the state child health plan does not substitute for coverage under group health plans. Check the appropriate box. (Section 2102)(b)(3)(C)) (42CFR 457.805) (42 CFR 457.810(a)-(c))

4.4.4.1. Coverage provided to children in families at or below 200% FPL: describe the methods of monitoring substitution. Labor analyses show that Texas has a low percentage of jobs in the manufacturing industries where dependent insurance coverage is highest. Employment in Texas is concentrated in retail, services and small business, all of which have low rates of employee health benefits, particularly for lower-paying positions. Also, program design for Texas SCHIP, with such features as a commercially-based benefits package and cost- sharing provisions, are similar to private insurance and will thereby diminish the differences in consumers’ minds