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.
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:
turns age 19 before the end of the certification period;
moves out of state or cannot be located;
enters a public institution;
dies;
requests a redetermination of eligibility and becomes eligible for another medical program, such as Medicaid without a spenddown or MWI premium. (See Section 703);
begins to be covered by a 'creditable' insurance under a group health plan or other health insurance coverage including COBRA;
becomes eligible to enroll in Medicare;
becomes covered by the Veterans Administration Health Care System;
fails to pay their quarterly premium and/or late fee;
fails to provide verification regarding access to employer sponsored health insurance when requested;
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)
fails to return verification for a change that occurred prior to 10-day notice of the review month; or
enrolls, or is eligible to enroll under a parent's or legal guardian's state employee group health plan.
When to Allow a Due Process Month
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)
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.
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:
A review is completed and ongoing eligibility for CHIP is established.
The agency receives report of a change that occurred before 10-day notice in the review month. The change affects the eligibility decision made at the review.
A member requests an income redetermination and they become eligible for a lesser cost CHIP plan (i.e. Plan C to Plan B).
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).
When a new application is submitted and CHIP eligibility has been re-determined. (See section 804 to determine what actions to take on changes)