602 Effective Date of Enrollment

Effective: April 1, 2011 - January 31, 2012

Previous Policy

1. Applications:

1. Application Month. The benefit effective date of CHIP enrollment is the first day of the month the application is received for each person determined eligible for CHIP at any time during the month.  This applies even if the person is not eligible at the time of application, unless one of the following exceptions listed below is true. (See Section 102-1 for information about application dates.)

If the applicant is not eligible for the application month, the same application can be used to determine eligibility for the following month.  When denying the original application month and determining eligibility for the next month, the application date and the benefit effective date changes to the first day of that next month, subject to the following exceptions.

EXCEPTIONS to benefits starting on the first day of a month:

• The individual applies during the first four days of the month and the 4-Day Grace Period is allowed.  See Section 602-1.

• The individual is enrolled in health insurance coverage that terminated involuntarily or COBRA coverage ends during the application month, in which case eligibility begins the day after the health insurance coverage ends.

• The individual is sanctioned for voluntary termination of health insurance coverage and the ineligibility period ends during the application month, in which case eligibility begins the day after the ineligibility period ends.

• The individual moved to Utah to take up residency during the application month, in which case eligibility cannot begin before the date the person arrived in Utah.

• The individual is a qualified alien who was subject to the five-year bar for CHIP during the application month, in which case eligibility cannot begin before the date the five-year-bar ended.

• The individual became a qualified alien who was not subject to the five-year bar during the application month, in which case eligibility cannot begin before the date the individual became a qualified alien.

• The individual is released from a Utah jail or prison or discharged from the State Hospital or other IMD, in which case eligibility cannot be earlier than the date the person was released.

2. Retroactive Months: There is no provision for retroactive coverage under the CHIP program.  See Section 602-1 for information on the four day grace period.

2. Reviews:

If a review is completed by the end of the review month, and the child continues to be eligible, the effective date of the new enrollment period is the first day of the month after the review month. 

A review received the month immediately following the review month becomes an application.  The effective date is the first day of that month.  (See Section 701-3.)

See Section 704 for more information about reviews.

3. Adding Eligible Children:

Children may be added to an open CHIP case at any time during the certification period without requiring a new application or verifying current income.  The child must still pass all other eligibility factors.  (See Section 701-5 and 804-3.)

Use the date of request as the application date except in the situations listed below:

1. Newborn child(ren):  

• If the family requests the coverage within 30 days of the child’s birth, the effective date of enrollment is the date of birth. 

• If the family requests the coverage more than 30 days after the child's birth, the effective date of enrollment is the first day of the month of the date of the request.

2. Newly adopted child(ren):

• If the family requests the coverage within 30 days of the child's finalized adoption, the effective date of the enrollment is the date the adoption was finalized.

• If the family requests the coverage more than 30 days after the child’s finalized adoption, the effective date of enrollment is the first day of the month the family requests to add the child.

3. Children who have been receiving Medicaid and lose Medicaid coverage.  The effective date of CHIP coverage is the day after the Medicaid ends.

4. Children who have been receiving UPP benefits and who choose to switch to CHIP.  The effective date of coverage is the day after the UPP reimbursable health insurance policy ends.

  Effective Date Example

5. Children who have been receiving CHIP and change to a new CHIP household cannot receive CHIP benefits in both households during the same month. Add the child or children to the new household the first day of the month after they have been removed from the previous CHIP household.  

Note:  All children being added to CHIP must be screened for Medicaid eligibility and meet all factors of CHIP eligibility.  A new income determination is not necessary when adding a child during the certification period.  (See 804-3 about adding eligible children to open CHIP cases.) CHIP should not be approved in the same month Medicaid has already issued.

See Section 702 for situations that allow you to re-open CHIP.

4. Ongoing Months

For all ongoing months after the application month is approved, eligibility begins on the first day of the month and extends through the end of the month.