CHIP
Policy
CHIP
Policy
When an enrollee is no longer eligible for CHIP, review the case and determine their eligibility for Medicaid or UPP. UPP only accepts new applications during open enrollment periods. The individual may also be eligible for an Advanced Premium Tax Credit (APTC) through the FFM.
When the following transitions occur, the requirements in B apply:
CHIP to UPP (within the CHIP certification period)
CHIP to UPP (when the CHIP certification period has ended)
CHIP to UPP to CHIP (within the CHIP certification period)
CHIP to UPP to CHIP (when the CHIP certification period has ended)
Do not require a new application.
Waive the open enrollment requirement for UPP if there has not been a break in coverage.
All eligibility factors must be met.
Do a new income determination.
Complete a new access to insurance test.
For a CHIP child to move from CHIP to UPP, the enrollee has 10 days from either the day the child is signed up or the date coverage begins, whichever is later, to report the insurance coverage.
If transitioning to UPP and all UPP eligibility requirements are met, end CHIP the day before the health insurance coverage begins and open UPP effective the day the health insurance coverage begins.
If transitioning to UPP or CHIP, open UPP or CHIP and authorize a new 12-month certification period. If transitioning to Medicaid, create a new review period.
Individual information will be transferred to the FFM if the individual is no longer eligible for Medicaid, CHIP or UPP.