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

Effective Date:

Approval Date: 7 income.

2.2. Describe the current state efforts to provide or obtain creditable health coverage for uncovered children by addressing: (Section 2102)(a)(2) (42CFR 457.80(b))

2.2.1. The steps the state is currently taking to identify and enroll all uncovered children who are eligible to participate in public health insurance programs (i.e. Medicaid and state-only child health insurance):

Children are identified and enrolled in Medicaid or SCHIP through a variety of mechanisms.

Medicaid applications are processed in local eligibility offices, hospitals, clinics throughout the state, and by the administrative services contractor. Applicants may apply in person, by phone, or by mail. The Texas Health and Human Services Commission (HHSC) processes all applications when families apply for children’s Medicaid and other related programs (such as Medicaid for adults, TANF, etc.). The administrative services contractor processes all children’s Medicaid applications when the application is only for children’s Medicaid and/or SCHIP. The administrative services contractor collects all required verification and then transmits the application, along with the required verification, electronically, to a centralized State office where a Medicaid worker makes the final eligibility determination for children’s Medicaid. HHSC is responsible for the administration of certain health and human services programs including the Texas Medicaid Program, SCHIP, and Medicaid waste, fraud, and abuse investigations. The agency also has oversight responsibilities for the four state Health and Human Services departments.

Out-stationed Eligibility Staff - HHSC outstations eligibility workers in clinics and hospitals. This staffs perform eligibility functions as well as screening functions for potential Medicaid and SCHIP eligibles. There is approximately 300 staff out-stationed in 190 facilities. The number of out-stationed eligibility staff in a facility is a function of the volume of eligibility determinations made at the facility. In some cases, disproportionate share hospitals (DSH) and Federally Qualified Health Centers (FQHCs) fund the state share of salary and benefits costs associated with staff above and beyond those required by federal law. Facilities that are not DSH hospitals or FQHCs can contract with HHSC for eligibility specialists and appropriate support staff to be placed in the facility. Under these contracts, the facilities also reimburse HHSC for the state share of the employee's salary and benefits.