Effective Date: January 1, 2024

Previous Policy

A child who is eligible and covered by CHIP receives 12-months of continuous eligibility. With some exceptions, the certification period begins with the first day of the month a completed and signed application is received if the applicant is determined eligible for CHIP.

See Section 701-2 and 220-9 for exceptions.

The certification period for CHIP is 12 months see section 703-1 for exceptions.

If the four day grace period coverage is approved, the certification period does not count those days as a month in the 12 month period.

Covered services the child received on or after the effective date of eligibility are payable by CHIP as long as the child remains covered.

The last month of the certification period is the review month.

If changes are discovered or reported during the 12 month certification period, only act on the information when the enrollee requests a Medicaid determination, asks for a new income redetermination, or the reported change is an exception to the 12 month certification period. Otherwise, only take action on changes at review or when a medical application is received. See sections 703-1 and 804 for more information on changes.

Request for an Income Redetermination or Medicaid : If an enrollee submits a new application, asks for Medicaid (in person, via phone, fax, email, in writing), or asks for a new CHIP income determination, redetermine the child’s eligibility for a better benefit. Determine the effect of the change on each child and take appropriate action. If the child is Medicaid eligible, end CHIP coverage and move the child to Medicaid.

If the change is a decrease in income and it makes the enrollee eligible for a lesser cost CHIP plan (i.e. Plan C to B), make the change effective the month of report when verified timely. Begin a new 12 month certification period. If not verified timely, make the change effective the month it is verified.

If the change is a decrease in income and it makes the enrollee eligible for Medicaid (without a spenddown or MWI premium), close CHIP and open Medicaid effective the month of report when verified timely. If not verified timely, make the change effective the month it is verified.

If the change is an increase in income and would make the enrollee ineligible for CHIP, continue CHIP through the end of the certification period.

No Request for Income Redetermination or Medicaid : Only make a change at review. If the enrollee reports an income change only, do not determine eligibility for a lower CHIP Plan or Medicaid. Continue CHIP through the end of their certification period. See Section 804-5 for more information about reported changes and Section 201-1 for Medicaid eligibility screening. Example: Enrollee reports via MyCase a decrease in hours worked. The enrollee has not asked for a better CHIP plan or Medicaid. The CHIP program continues through the end of the current certification period. If the change becomes known through interface matches or tasks, continue the certification period and take action at review.