805 Case Closure

Effective: July 1, 2017

Previous Policy

1. When an enrollee requests his case be closed or when no one in the household is eligible, close the case and send proper notice. (See 220-2 for information about children who enroll in private health insurance.)
2. When a member receives improper CHIP coverage and there are no other CHIP eligible individuals, close the CHIP in the month the agency can give proper notice (803 & 806).
3. If you cannot give 10-day advanced notice for any adverse actions, continue benefits to the following month. (See 803 for exceptions to 10-day advance notice requirements.)
4. If a CHIP case closes because all of the children become eligible for Medicaid and then Medicaid eligibility is lost, re-determine eligibility for CHIP.  A new application form is not required; however, all factors of eligibility must be verified and met.
5. When a CHIP member requests UPP and is determined eligible, continue CHIP through the end of their enrollment period unless the member provides proof of enrollment in their employer sponsored health insurance.

If the member provides verification, close the CHIP at the end of the month for which the eligibility agency can give proper 10-day notice.  

1. Individual information will be transferred to the FFM if the individual is no longer eligible for CHIP.