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o The individual through whom the insurance was available failed to enroll in the employer’s health insurance coverage because one or more members of the individual’s family were covered through: o A private health insurance policy or Medicaid, and o No one in the family was covered through SCHIP.

Other good cause exemptions, consistent with the above reasons, may be approved by the Department of Health Services on a case by case basis.

4.1.8

Duration of eligibility:

Eligibility lasts until the birth of the baby for unborn children covered under SCHIP and for 12 months or until determined ineligible for all other children.

4.1.9

Other standards (identify and describe):

An SSN is not required for non-qualifying immigrants, but is required for all others.

Wages and availability of employer-sponsored health insurance must be verified by the employer.

4.2 The state assures that it has made the following findings with respect to the eligibility standards in its plan: (Section 2102)(b)(1)(B)) (42 CFR 457.320(b)) 4.2.1

These standards do not discriminate on the basis of diagnosis.

4.2.2

Within a defined group of covered targeted low-income children, these standards do not cover children of higher income families without covering children with a lower family income.

4.2.3

These standards do not deny eligibility based on a child having a pre-existing medical condition.

4.3 Describe the methods of establishing eligibility and continuing enrollment. (Section 2102)(b)(2)) (42 CFR 457.350)

The methods of establishing eligibility and continuing enrollment are the same as under Title XIX.

4.3.1 Describe the state’s policies governing enrollment caps and waiting lists (if any).

WISCONSIN

Effective Date:

Approval Date: 17