CHIP Policy

703-1 Length of the Certification Period

Effective Date: June 1, 2025

Previous Policy

The certification period for CHIP is 12 months. Once a child is determined eligible for CHIP, the child remains eligible for the entire certification period, with few exceptions.

1. Exceptions to the 12-Month Certification Period

In the following situations, eligibility may change or end before the end of the 12-month certification period if a member:

1. turns age 19 before the end of the certification period (see section 210);
2. moves out of state;
3. dies;
4. Change in immigration status;
5. The member requests voluntary termination;
6. The member is eligible for Medicaid and requests to move programs.
7. The covered child is pregnant or in the 12 month postpartum period;
8. Requests a redetermination of eligibility and becomes eligible for another medical program, such as Medicaid without a spenddown or MWI premium. (See Section 703);
9. Reports a change that was required to be reported at review which causes a change to eligibility for the new certification period; (See Section 102-3)
10. The agency determines that eligibility was determined incorrectly at the most recent determination or redetermination of eligibility because of agency error or fraud, abuse or perjury attributed to the individual;

2. When to Allow a Due Process Month

1. Reviews - If you cannot give 10-day notice before determining eligibility, extend benefits to the following month. This month is not part of any certification period. (See Sections 704 & 803)
2. Change Report - When you cannot give 10-day notice for an adverse action, continue benefits to the following month.  This month remains part of the current certification period.

3. When to Establish a New 12-Month Certification Period

The enrollment period for CHIP must be re-determined at 12 months.  A new 12-month certification period may be established when:

1. A review is completed and ongoing eligibility for CHIP is established.
2. The agency receives a report of a change that occurred before 10-day notice in the review month. The change affects the eligibility decision made at the review.
3. A member requests an income redetermination and they become eligible for a lesser cost CHIP plan (i.e. Plan C to Plan B).
4. A member requests an income redetermination when completing a review on another program and all information needed to determine CHIP eligibility has been provided and CHIP eligibility does not change to a higher cost plan (Plan B to Plan C).
5. When a new application is submitted and CHIP eligibility has been re-determined. (See section 804 to determine what actions to take on changes)