Effective Date: July 1, 2024

Previous Policy

Adding a child during the certification period

A child may be added to an open CHIP case without requiring a new application. All other eligibility requirements must be met. Starting a new certification period may change the member’s cost sharing requirement. (See Section 701 )

Determine if the child applying for CHIP is eligible for coverage under Medicaid. If the child is eligible for Medicaid, the child is not eligible to be added to the CHIP household. A child, who only qualifies for Medicaid by paying a monthly spenddown and chooses not to meet the spenddown each month, may be added to CHIP. If it is clear that the applicant does not meet the requirements for Medicaid, do not request any verification that does not apply to CHIP enrollment.

If the child is eligible for CHIP, add the child for the remainder of the current certification period.

If the new child’s countable income is over the income limit for CHIP, the agency will transfer the electronic record to the Federally Facilitated Marketplace (FFM) for that child.

Children who have been receiving CHIP and move to a new CHIP household cannot receive CHIP benefits in both households during the same month. Add the child or children to the new household the first day of the month after they have been removed from the previous CHIP household. CHIP cannot be approved in the same month Medicaid has already issued.

Medicaid Screening

If Medicaid screening shows the additional child may be Medicaid eligible, request needed verifications including current income and then take the following action: If current income is provided and the child meets all factors of Medicaid eligibility - add the child to Medicaid. Any other children in the household who are eligible for Medicaid, must be removed from CHIP and opened for Medicaid. If current income is provided and the child does NOT meet Medicaid income eligibility, add the child to CHIP if the child meets the income limit and all other eligibility criteria. Do NOT use the new income or change the certification period if the income adversely affects eligibility and changes the CHIP plan from Plan B to Plan C. Use the newly verified income and begin a new certification period if income makes the member eligible for a lesser cost CHIP plan. If the member fails to provide current income, deny Medicaid for the additional child and do not add the child to CHIP.

Note: The out of pocket maximum, co-payment and deductibles could also change. The worker must educate the member about how this change may affect their cost-sharing requirement.

Effective Date of Enrollment in CHIP

A newborn child, newly adopted child, child placed for adoption or a child placed for foster care that are not already insured may be added to the CHIP program if the request or application is within 60 days of the event. The child’s coverage effective date will be the date of the event, if eligible.

If the request or application is filed more than 60 days after the event, the effective date of CHIP enrollment is the first day of the month in which the request or application was filed.

Other Children: Children who are not enrolled in a health plan at the time of application, the effective date to enroll in CHIP is the first day of the application month. (See Section 701-2 ) Children who are enrolled in an FFM plan at the time of application, the effective date to enroll in CHIP is the day following the termination date of the FFM plan. The effective date for children being re-opened in conjunction with a new application is the same date as the additional child. See section 701-1 and 702 for more information. The effective date for a child that loses Medicaid coverage is the day following the termination date of the Medicaid.

Adding a Child Increases the Household Size

After adding a child to CHIP, the household size change may result in a change in the plan level. Before the plan level can be changed, current household income must be requested for a new income determination.

Leave the CHIP case open and take no further action if: Current income is not provided; OR Current income is provided and the new income adversely affects the current eligibility (changes from plan B to C). Post the new income best estimate.

If the new income best estimate causes the member to remain on the same plan or the individual(s) are now eligible for Plan B, (IE: plan C to plan C; plan B to plan B; plan C to plan B ) begin a new certification period starting the next possible issuance month.

Note : T he out of pocket maximum, co-payment and deductibles could also change. The worker must educate the member about how this change may affect their cost-sharing requirement.

Check eligibility factors for all household members.