703  Enrollment Period

Effective Date: April 1, 2011 - January 31, 2012

Previous Policy

The enrollment period includes all months an enrollee is eligible. 

1. The enrollment period begins with the first day of the month  a completed and signed application is received if the applicant is determined eligible for CHIP with few exceptions.  See Section 602. The enrollment period for CHIP is 12 months.  If the four day grace period coverage is approved, the enrollment period begins with the beginning date of the grace period coverage.  (See Section 602-1) Covered services the child received on or after the date of application are payable by CHIP for a child who was eligible upon application.

2. The last month of enrollment is the review month.  See Section 704-1 for information about a CHIP eligibility review.

3. If changes are discovered or reported during the 12 month enrollment period, only act on the information when the enrollee requests a Medicaid determination, asks for a new income determination, or the reported change is an exception to the 12 month enrollment period.  Otherwise, only take action on changes at review or when a medical application is received.  (See Section 703-1 and see Section 804 for more information on changes.)

1. Request from Enrollee:  If an enrollee submits a new application, asks for Medicaid in person, or via phone, fax, email, or in writing, or asks for a new CHIP income determination; determine the child’s eligibility for Medicaid.  If Medicaid eligible, close CHIP and open Medicaid for all Medicaid eligible household members.

• If the change is a decrease in income and the change makes the enrollee eligible for a lesser cost CHIP plan (i.e. Plan C to Plan B/A or Plan B to Plan A), make the change to the lesser cost plan the first month the change can be made.  Begin a new 12 month enrollment period.

• If the change is a decrease in income and the change makes the enrollee eligible for Medicaid without a spenddown, pregnant woman asset co-payment, or MWI premium, close CHIP and open Medicaid, even if the enrollee only requested a CHIP income redetermination.

• If any other change makes the enrollee eligible for Medicaid without a spenddown, pregnant woman asset co-payment, or MWI premium, remove the child from CHIP and open Medicaid.

• If the change makes the enrollee ineligible for CHIP, but not Medicaid eligible, continue CHIP until the end of the enrollment period unless the change is an exception to the 12 month enrollment period policy.  See these exceptions in 703-1.

2. No Request for Redetermination or Medicaid:  Only make a change at application or review.

• If the enrollee does not request a new CHIP income determination or Medicaid coverage, do not determine eligibility for a lower CHIP Plan or Medicaid.  Continue CHIP through the end of their enrollment period.  See Section 804-5 for more information about reported changes and Section 201-1 for Medicaid eligibility screening.

• If the change becomes known through interface matches or tasks; continue the enrollment period and take action at application or review.

4. The enrollment period ends if a CHIP family does not pay their quarterly premium.  CHIP may be reinstated if the family pays the quarterly premium by the last day of the month immediately following the closure.