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28 Effective Date: July 1, 2001

Approval Date: to set up a hearing. OAH notifies the client and the agency’s Administrative Hearing Coordinator. The Coordinator prepares the case and sets up a pre-hearing conference as a way to settle the dispute or collect information. Cases that are not resolved in the pre-hearing conference proceed to an Administrative Hearing. At the Administrative Hearing, an Administrative Law Judge gathers information from the client and agency staff. Hearings can be conducted via telephone or in person. The Judge’s decision is mailed to the client and the Administrative Hearings Coordinator. Either party may appeal the decision for additional review and if need be, to the courts.

4.3.1 Describe the State’s policies governing enrollment caps and waiting lists (if any). (Section 2106(b)(7)) (42CFR 457.305(b))

Check here if this section does not apply to your State.

4.4. Describe the procedures that assure that:

4.4.1. Through the screening procedures used at intake and follow-up eligibility determination, including any periodic redetermination, that only targeted low-income children who are ineligible for Medicaid or not covered under a group health plan or health insurance coverage (including a state health benefits plan) are furnished child health assistance under the state child health plan. (Section 2102)(b)(3)(A)) (42CFR 457.350(a)(1) and 457.80(c)(3))

At the time of application and redetermination, eligibility staff first determines whether an applicant or recipient is eligible for Medicaid. If the child is not Medicaid eligible, staff assesses eligibility for CHIP and enrolls them in CHIP, if appropriate. To assist in this process, eligibility staff uses ACES automated protocols. In addition, there is a series of required questions on the application and eligibility review form that ask about the child’s health insurance status. If these questions are not answered at the time of application or review, the applicant is sent an “Insurance Information Request” letter, which must be completed before eligibility can be determined.

The State’s MMIS system is also checked at the time of application and re- determination to see if there is any history of a third party insurance. In addition, the Coordination of Benefits section reviews a monthly report of currently eligible CHIP