1701-3 Effective Dates of Certification

Effective Date: January 1, 2024

No Previous Policy

A. New CHIP Applicants

1. State CHIP enrollment begins the first day of the month during open enrollment and the member is a Utah resident for 180 days when the program enrollment maximum has not been met.

If any family member is enrolled in an FFM plan see section 220-9 to determine the effective date for CHIP.

Exceptions to benefits starting on the first day of a month:

· The individual applies during the first four days of the month and the 4-Day Grace Period is allowed.

· The individual is enrolled in health insurance coverage that terminated involuntarily or COBRA coverage ends during the application month, in which case eligibility begins the day after the health insurance coverage ends.

· The individual is sanctioned for voluntary termination of health insurance coverage and the ineligibility period ends during the application month, in which case eligibility begins the day after the ineligibility period ends.

If the applicant is not eligible for the application month, the same application can be used to determine eligibility for the following month. 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 that next month.

A Medicaid or UPP recipient reports a change that causes the member to no longer be eligible for Medicaid or UPP, but the member does qualify for State CHIP and it is during open enrollment or an exception to open enrollment. The effective date of coverage for CHIP is the first day of the month immediately following the Medicaid or UPP closure.

B. Four Day Grace Period

A State CHIP applicant is eligible for the four day grace period when open enrollment spans both months.

When an application is received during the first four days of a month and a child has a medical need, allow a grace enrollment period beginning no earlier than four days prior to the date an applicant submits a completed and signed application.

To receive the coverage, the applicant must have been unable to apply during the last four days of the previous month because of an emergency situation.

The applicant must request that eligibility be determined for the grace period before the application process is completed. If they fail to request it until after their application is approved, they are not eligible for the grace period coverage.

All factors of eligibility must be met in the grace period.

Consider eligibility for the Child Medically Needy program when the grace period does not match the dates of medical need.

Examples

An application is received on April 1 for State CHIP. The child had a medical need on March 28. Open enrollment runs from March 25 through April 10. The grace period and State CHIP coverage can go back to March 28.

An application is received October 2 for State CHIP. The child has a medical need on September 30. Open enrollment runs from October 1 through October 6. Can not review for the grace period. Can still consider Emergency Medicaid for September.

An application is received on July 3 for State CHIP. The child had a medical need on June 27. Open enrollment runs from June 1 through July 15. The earliest date for the grace period is June 29. Can still consider Emergency Medicaid coverage for the month of June.

An application is received May 2 for State CHIP. The Child had a medical need on April 28. Open enrollment runs from April 30 through May 15. The earliest date for the grace period is April 30 when open enrollment began. Can still consider Emergency Medicaid for April.