1700 Eligibility Determination and Redetermination

Effective Date: January 1, 2024

No Previous Policy

This section describes the eligibility determination process for State CHIP see CHIP policy section 700 for rules that are not specifically covered in these sections.

Eligibility is determined whenever a customer applies during State CHIP open enrollment, requests an income redetermination or requests Medicaid. Eligibility is also determined when a case is reviewed at the end of the certification period.

Determine an enrollee’s eligibility by applying the program and income standards in the policy manual to the individual's circumstances, and by establishing the validity and accuracy of the information given by the applicant. See Section 705 for information about the verification process.

Refer to CHIP sections for State CHIP:

1701 Application

1702 Re-Opening CHIP

703 Certification Period

704 Eligibility Review

705 Verification

706 Income Match