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28 Effective Date: July 1, 2001
Approval Date: clients to see whether any clients have health insurance coverage.
At application or review a child applying for, or enrolled in, CHIP will not be eligible for the program if they are covered under a group health plan or health insurance coverage; has access to, or coverage under, a state health benefits plan; or are Medicaid eligible.
4.4.2. The Medicaid application and enrollment process is initiated and facilitated for children found through the screening to be potentially eligible for medical assistance under the state Medicaid plan under Title XIX. (Section 2102)(b)(3)(B)) (42CFR 457.350(a)(2))
All applications are first reviewed for Medicaid eligibility. Applicants are enrolled in Medicaid if eligible. This process is automated through ACES automated protocols. Eligibility for CHIP is determined only after eligibility for Medicaid is reviewed and the child is found ineligible for Medicaid.
4.4.3. The State is taking steps to assist in the enrollment in CHIP of children determined ineligible for Medicaid. (Sections 2102(a)(1) and (2) and 2102(c)(2) (42CFR 431.636(b)(4))
The ACES eligibility system automatically checks for Medicaid eligibility prior to consideration of eligibility for CHIP. After Medicaid ineligibility is determined, ACES automatically checks for CHIP eligibility based on the applicant’s income level.
4.4.4 The insurance provided under the State Child Health Plan does not substitute for coverage under group health plans. Check the appropriate box. (Section 2102)(b)(3)(C)) (42CFR 457.805) (42 CFR 457.810(a)- (c))
4.4.4.1. Coverage provided to children in families at or below 200% of the FPL: describe the methods of monitoring substitution.
4.4.4.2. Coverage provided to children in families over 200% and up to 250% of the FPL. Describe how substitution is monitored and identify specific strategies to limit substitution if levels become unacceptable.
In several ways, the State ensures that substitution of coverage does not occur. First,