Effective Date: June 1, 2025

Previous Policy

The certification period for CHIP is 12 months. Once a child is determined eligible for CHIP, the child remains eligible for the entire certification period, with few exceptions.

Exceptions to the 12-Month Certification Period

In the following situations, eligibility may change or end before the end of the 12-month certification period if a member:

turns age 19 before the end of the certification period (see section 210 );

moves out of state;

dies;

Change in immigration status;

The member requests voluntary termination;

The member is eligible for Medicaid and requests to move programs.

The covered child is pregnant or in the 12 month postpartum period;

Requests a redetermination of eligibility and becomes eligible for another medical program, such as Medicaid without a spenddown or MWI premium. (See Section 703 );

Reports a change that was required to be reported at review which causes a change to eligibility for the new certification period; (See Section 102-3 )

The agency determines that eligibility was determined incorrectly at the most recent determination or redetermination of eligibility because of agency error or fraud, abuse or perjury attributed to the individual;

When to Allow a Due Process Month

Reviews - If you cannot give 10-day notice before determining eligibility, extend benefits to the following month. This month is not part of any certification period. (See Sections 704 & 803 )

Change Report - When you cannot give 10-day notice for an adverse action, continue benefits to the following month. This month remains part of the current certification period.

When to Establish a New 12-Month Certification Period

The enrollment period for CHIP must be re-determined at 12 months. A new 12-month certification period may be established when:

A review is completed and ongoing eligibility for CHIP is established.

The agency receives a report of a change that occurred before 10-day notice in the review month. The change affects the eligibility decision made at the review.

A member requests an income redetermination and they become eligible for a lesser cost CHIP plan (i.e. Plan C to Plan B).

A member requests an income redetermination when completing a review on another program and all information needed to determine CHIP eligibility has been provided and CHIP eligibility does not change to a higher cost plan (Plan B to Plan C).

When a new application is submitted and CHIP eligibility has been re-determined. (See section 804 to determine what actions to take on changes)