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28 Effective Date: July 1, 2001

Approval Date: both the application and the eligibility review form ask a series of questions regarding health insurance status of the applicant’s children. If they respond affirmatively to any of these questions, we ask the applicant to list the name of the insurance company or employer providing the insurance. The following individuals are ineligible for CHIP: Anyone who at the time of application or redetermination is covered under a group health plan or health insurance coverage; has access to, or coverage under, a state health benefits plan; or who is Medicaid eligible. If the client does not respond to the questions, they are sent an “Insurance Information Request” letter that the applicant must respond to in order for CHIP eligibility to be determined. If the client has access to health insurance coverage, they are not enrolled in CHIP. Also, at the time of application and redetermination the MMIS is checked to see if there is any history showing of insurance coverage for the household. If a history shows, further inquiries can be made. To monitor substitution of coverage, the State tracks responses on the number of applications and eligibility reviews that show the applicant has insurance coverage. In addition, the State tracks the number of applications and eligibility reviews that are denied due to insurance coverage.

Additionally, the State tracks whether the applicant has disenrolled from employer sponsored coverage. If the applicant has lost employer sponsored insurance coverage within the past 4 months, the child must serve a four-month waiting period. However, prior to imposing a waiting period, we look at whether one of nine exceptions applies to the family’s situation. Exceptions to the four-month waiting period may be granted when: 1) Parent lost job that has medical coverage for children. 2) Parent with medical insurance died. 3) Child has a medical condition that, without medical care, would cause serious disability, loss of function or death. 4) Employer ended medical coverage for children.