DHHS - CHIP Policy Manual
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OBSOLETE POLICY

CHIP MANUAL

 

201-1 Screening for Medicaid Eligibility

Effective: April 1, 2011

Previous Policy

Use the income section of the application or review to screen for Medicaid eligibility.

  1. Application:

A.     If the household income shows that the child could be eligible for a Medicaid program that will require a spenddown of excess income, pregnant woman asset co-payment, or MWI premium; inform the family about their possible Medicaid eligibility.  If they do not want to proceed with a Medicaid application, determine their eligibility for CHIP.

B.      If the household income is below the income limits for Medicaid, and it appears that the household is eligible for Medicaid without paying a spenddown, request the information or verification from the applicant  that you need to determine Medicaid eligibility.

1)  If the applicant does not provide the necessary forms or verifications, or does not wish to proceed with a Medicaid application, deny the CHIP application.

2)  If the applicant is eligible for Medicaid, deny the CHIP application.

  1. Review:

A.     Screen the review to determine if any of the children can qualify for Medicaid.  Use the same process that you use to screen an application.

B.      Remove any child from CHIP, who is eligible for Medicaid.

C.     Proceed with the CHIP review if any of the children are not eligible for Medicaid.

  1. Reported Changes:

    1. Income decreases:

1)  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.

2)  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.

  1. All other changes: If changes are discovered or reported during the 12 month enrollment period, screen for Medicaid eligibility only when the enrollee requests a Medicaid determination, or asks for a new income determination.

1)  Review the change to determine if the change causes an enrollee to qualify for Medicaid.

2)  Remove any child from CHIP who is Medicaid eligible.

3)  Continue the enrollee on the CHIP program through the end of their enrollment period if the reported change does not change their Medicaid eligibility.