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51 Effective Date: July 1, 2009

Approval Date:

State has established a process that gives enrollees reasonable notice of and an opportunity to pay past due premiums, copayments, coinsurance, deductibles or similar fees prior to disenrollment. (42CFR 457.570(a)) The department has an established process that continues the child’s CHIP coverage even when premiums are not paid. Each month the client is notified in writing of the amount of their current premium, plus the balance of any delinquent premiums that have not been paid. Clients are not disenrolled for non-payment of premiums until they have missed three consecutive months of payment. Once the enrollee is three months in arrears, the enrollee is sent a letter advising them of disenrollment effective the end of the month unless the delinquent premium is paid in full. At any time prior to the end of the certification period the enrollee will be reinstated back to the month of disenrollment if the delinquent premium is paid. The letter gives them a toll-free number to call to make payment arrangements or to report a change in circumstances that may make them eligible for Medicaid. The letter also advises them of their right to an Administrative Hearing if they disagree with the decision to terminate benefits, and a right to continued benefits pending the outcome of the Administrative Hearing.

The disenrollment process affords the enrollee an opportunity to show that the enrollee’s family income has declined prior to disenrollment for non-payment of cost-sharing charges. (42CFR 457.570(b)) Prior to disenrollment, clients are notified in a letter that they can call a toll-free number to report any changes in income or household. This allows their eligibility to be determined for Medicaid or any programs for which they may be eligible.

In the instance mentioned above, that the state will facilitate enrolling the child in Medicaid or adjust the child’s cost-sharing category as appropriate. (42CFR 457.570(b))

Once the State’s eligibility section is notified of a change in income, they will automatically review eligibility for Medicaid.

The state provides the enrollee with an opportunity for an impartial review to address disenrollment from the program. (42CFR 457.570(c))

Enrollees are sent a letter informing them of disenrollment from CHIP. The letter