1250 Open Enrollment Periods

Effective Date: January 1, 2024

No Previous Policy

Open Enrollment

The Department of Health and Human Services limits the number of eligible individuals covered under State CHIP. The eligibility agency accepts applications only during certain State CHIP open enrollment periods.

State CHIP Applications

A complete application must be submitted during the open enrollment period to be considered for enrollment. This includes applications for individuals residing in households with open Medicaid cases, who are not included in the Medicaid coverage because they do not qualify for a Medicaid program.

Applications may be submitted by various methods. 102-1 State CHIP coverage can begin no earlier than the first day of the month the application is received. A State CHIP application that has health insurance coverage that will end during the open enrollment period or by the end of the month immediately following the open enrollment period may be considered for State CHIP. The effective date for the State CHIP coverage would be the first day after the coverage ends. A State CHIP applicant who applies during open enrollment but is not eligible for the application month can be reviewed to determine eligibility for the following month even if the following month is not during open enrollment. When denying the original application month and determining eligibility for the next month, the application date and the benefit effective date changes to the first day of the next month as an exception to open enrollment.

Exceptions to Open Enrollment for State CHIP Reviews If a State CHIP recipient fails to complete the review process during the review month and the case closes at the end of the review month, the member has three additional months from the date of case closure to complete the review process without submitting a new application. If a due process month was issued to give proper notice the three-month period begins after the month the case closed for not completing the review process.

Waive the State CHIP open enrollment requirement if the review process is completed or a new application is received in the three-month period immediately following the month the review closed for incomplete review.

The application processing time period applies. The new application date is the date the review, review verification or application is received. The client must provide requested verification within the application processing time period.

If eligible, the first day of the month in which the recipient contacts the agency is the new effective date. There is no retroactive benefit, and no interview or application form is required.

An application received more than three months after the case closes for incomplete review will be denied if it is not an open enrollment period.

Exceptions to Open Enrollment for State CHIP Reported Changes

If a State CHIP recipient submits requested verification for a reported change after the case was closed but by the effective date of the closure, and there is not time to send 10 day notice of an adverse action, reopen State CHIP and extend benefits to the next month while eligibility is being determined.

If a State CHIP recipient submits all requested verification for a reported change after the effective closure date, and by the last day of the month after closure, treat the verification as a new application.

Waive the State CHIP open enrollment requirement in the month immediately following the closure.

The new application date is the date all requested verification is received.

The member must provide any additional verification within the application processing time period.

If the requested verification is received more than one month after the closure, the member must wait to reapply at the next open enrollment period.

If a child loses eligibility to Medicaid or CHIP due to a loss of citizenship/immigration status this is an exception to open enrollment for State CHIP.

A member who loses eligibility to Medicaid or CHIP due to a loss of citizenship/immigration status and is pregnant can move to State CHIP even if they are 19 years old. This change creates an exception to open enrollment.

Emergency Medicaid back to State CHIP

There is no State CHIP open enrollment requirement when an individual is moving from the Emergency Medicaid program to the State CHIP program and there is no break in coverage as long as the individual was found eligible for State CHIP during the last open enrollment period and the member opted for Emergency Medicaid at that time. The State CHIP application date is the first of the month after Emergency Medicaid ends.

Pending Medical Applications

Consider State CHIP for any child who is included in the household for a medical application that is pending when open enrollment begins. The State CHIP effective date is the first day of the month open enrollment began. A new application is not required.

Medicaid Closures and Denials

Consider State CHIP eligibility in the following situations: (A new application is not required.)

A Medicaid case is closed during open enrollment and eligibility will end on the last day of the open enrollment month or the month immediately following the open enrollment period. The effective date of coverage for State CHIP is the first day of the month immediately following the closure.

A Medicaid recipient reports a change during an open enrollment period, returns requested verification by the due date, and the client is determined to be ineligible as of the last day of the open enrollment month or the month immediately following the open enrollment period. The effective date of coverage for State CHIP is the first day of the month immediately following the closure.

An individual applies for Medicaid before the open enrollment period and returns all requested verification by the due date during the open enrollment period and the applicant is determined to be ineligible. The State CHIP effective date is the first day of the month open enrollment began.

Medicaid Reviews

Consider State CHIP eligibility in the following situation:

A Medicaid household turns in a review form or requested verifications during an open enrollment period, and you determine that children in the household may be eligible for the State CHIP program. Consider State CHIP for those children. The effective date of coverage for State CHIP begins the first day of the month immediately following the Medicaid closure and a new application is not required.