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

Effective Date:

Approval Date: 22 between group health plans and SCHIP. Up to 150% FPL, crowd out is not anticipated to be a significant issue. The data are less clear at incomes between 150% and 200% FPL. Consequently, the program requires that applicants be uninsured for 90 days as a condition of eligibility. Provision is made to exempt families whose coverage has been discontinued through no fault of their own or who have discontinued coverage because the cost exceeded 10% of family income.

The application screens for whether the child has current insurance. If that is the case, eligibility for SCHIP is denied. If the application indicates that other insurance coverage was in effect during the previous 90 days, the applicant must indicate the date coverage ended, the reason, and the cost of the coverage. This information is used to determine if the children meet a good cause exception to the 90-day waiting period.

The State also monitors for substitution of coverage through SCHIP consumer surveys conducted by the External Quality Review Organization, evaluation of trends indicated by administrative data (e.g.: rates of “good cause” exceptions granted), and evaluation of statewide trends in insured/uninsured rates as indicated by the Current Population Survey (CPS) data.

4.4.4.2. Coverage provided to children in families over 200% and up to 250% FPL: describe how substitution is monitored and identify specific strategies to limit substitution if levels become unacceptable.

4.4.4.3. Coverage provided to children in families above 250% FPL: describe how substitution is monitored and identify specific strategies in place to prevent substitution.

4.4.4.4. If the state provides coverage under a premium assistance program, describe:

The minimum period without coverage under a group health plan, including any allowable exceptions to the waiting period.

The minimum employer contribution.

The cost-effectiveness determination.

4.4.5 Child health assistance is provided to targeted low-income children in