CHIP
Policy
CHIP
Policy
If the child does not qualify as an SSI recipient, Parent/Caretaker Relative, Former Foster Care Child, or Pregnant Woman, use the MAGI-based income and household composition to determine Medicaid eligibility for Child Medicaid.
If the MAGI-based income for the child is below the applicable poverty-level income limits for Child Medicaid, the child is Medicaid eligible. Complete the eligibility decision and notify the family.
If the MAGI-based income for the child is above the applicable poverty-level income limits for Child Medicaid, and not over the income limit for CHIP, determine eligibility for CHIP.
If the household income shows that the child could be eligible for a Medicaid program that will require a spenddown of excess income, or MWI premium, determine their eligibility for CHIP.
Screen the review to determine if any of the children can qualify for Medicaid. Use the same process that you use to process an application.
Remove any child from CHIP who is eligible for Medicaid.
Proceed with the CHIP review for any child who is not eligible for Medicaid.
Income decreases:
If the enrollee reports a decrease in income, and requests Medicaid coverage for any household member, or a new income determination, remove any child from CHIP who is eligible for Medicaid.
If the enrollee does not request Medicaid or a new income determination, continue CHIP through the end of their enrollment period. At review, redetermine Medicaid eligibility using the MAGI-based household composition and MAGI-based income amounts.
If other changes are discovered or reported during the 12 month enrollment period, determine Medicaid eligibility only when the enrollee requests a Medicaid determination, or asks for a new income determination.
Review the change to determine if the change causes an enrollee to no longer qualify for CHIP and take appropriate actions.
Remove any child from CHIP who is Medicaid eligible.
Continue the enrollee on the CHIP program through the end of their enrollment period if the reported change does not make the child eligible for Medicaid (and it also does not make the child ineligible for CHIP.) (See Sec. 703-1 for changes that can result in CHIP eligibility ending.)