DHHS - CHIP Policy Manual
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  CHIP Policy

701-4 What to do with an Application

Effective Date: November 1, 2024

Previous Policy

 

  1. Each application must be processed to a decision for every applicant unless:

    1. The individual and other household members are already on the most beneficial medical program. (See section 102-1 when a new medical application is received for an open CHIP case.) If no better coverage is available, document that no action was taken on the application.

    1. The individual has already applied and that application is still pending. (See section 102-1.)

    1. The individual withdraws the application.

    1. The individual cannot be located, in which case deny the application. If the individual contacts the agency before the end of the application-processing period, resume the application process.

  1. Deny applications that do not meet the signature requirements within the application-processing time as an incomplete application. Do not make a determination of eligibility. See section 102-1 and 701 on who can apply and how to get the best signature.

  1. All applicants have the right to register to vote at application (101).

  1. Determine if any child applying for CHIP is eligible for coverage under Medicaid.

    1. A child who is eligible for Medicaid is not eligible for CHIP.

    1. A child enrolled in an FFM plan may be eligible for CHIP if determined ineligible for Medicaid (220-9).

  1. A child who is only eligible for Medicaid with a spenddown and chooses not to pay it may be eligible for CHIP. (If an individual wants Medicaid with a spenddown, additional verification may be needed to determine eligibility. Determine CHIP eligibility for any applicant who has applied for Medicaid, but was found ineligible. A new application is not required.

  1. Screen the application and address all factors of eligibility. 705 details the various methods of verification.

  1. Request any needed verifications.

    1. An interview may be helpful in gathering information, but is not required.

    1. If the applicant has expenses and not enough income to cover them, the applicant must verify how they are meeting their expenses (705).

    1. If the application has health insurance listed, the agency must determine if insurance is an FFM plan (220-9).