General description of eligibility standards and methodology
(1) Eligibility standards
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(A) In general The plan shall include a description of the standards used to determine the eligibility of targeted low-income children for child health assistance under the plan. Such standards may include (to the extent consistent with this subchapter) those relating to the geographic areas to be served by the plan, age, income and resources (including any standards relating to spenddowns and disposition of resources), residency, disability status (so long as any standard relating to such status does not restrict eligibility), access to or coverage under other health coverage, and duration of eligibility. Such standards may not discriminate on the basis of diagnosis.
(B) Limitations on eligibility standards Such eligibility standards— (i) shall, within any defined group of covered targeted low-income children, not cover such children with higher family income without covering children with a lower family income; (ii) may not deny eligibility based on a child having a preexisting medical condition; (iii) may not apply a waiting period (including a waiting period to carry out paragraph (3)(C)) in the case of a targeted low-income pregnant woman provided pregnancy-related assistance under section 1397 ll of this title; (iv) at State option, may not apply a waiting period in the case of a child provided dental-only supplemental coverage under section 1397jj(b)(5) of this title ; and (v) shall, beginning January 1, 2014 , use modified adjusted gross income and household income (as defined in section 36B(d)(2) of the Internal Revenue Code of 1986) to determine eligibility for child health assistance under the State child health plan or under any waiver of such plan and for any other purpose applicable under the plan or waiver for which a determination of income is required, including with respect to the imposition of premiums and cost-sharing, consistent with section 1396a(e)(14) of this title .
The plan shall include a description of methods of establishing and continuing eligibility and enrollment.
The plan shall include a description of procedures to be used to ensure—
(A) through both intake and followup screening, that only targeted low-income children are furnished child health assistance under the State child health plan;
(B) that children found through the screening to be eligible for medical assistance under the State medicaid plan under subchapter XIX are enrolled for such assistance under such plan;
(C) that the insurance provided under the State child health plan does not substitute for coverage under group health plans;
(D) the provision of child health assistance to targeted low-income children in the State who are Indians (as defined in section 1603(c) 1 1 See References in Text note below. of title 25); and
(E) coordination with other public and private programs providing creditable coverage for low-income children.
(A) In general Subject to subparagraph (B), the plan shall include a description of the procedures used to reduce administrative barriers to the enrollment of children and pregnant women who are eligible for medical assistance under subchapter XIX or for child health assistance or health benefits coverage under this subchapter. Such procedures shall be established and revised as often as the State determines appropriate to take into account the most recent information available to the State identifying such barriers.
(B) Deemed compliance if joint application and renewal process that permits application other than in person A State shall be deemed to comply with subparagraph (A) if the State’s application and renewal forms and supplemental forms (if any) and information verification process is the same for purposes of establishing and renewing eligibility for children and pregnant women for medical assistance under subchapter XIX and child health assistance under this subchapter, and such process does not require an application to be made in person or a face-to-face interview.