OBSOLETE POLICY CHIP MANUAL |
Effective: January 1, 2014 - January 31, 2015
Special Rules for Reviews in January-March 2014
Initially, use MAGI rules to determine eligibility. If individuals are eligible, re-certify the CHIP for 12 months. If the individuals are eligible for Medicaid using the MAGI methodology, close the CHIP and open Medicaid.
If the individuals fail both Medicaid and CHIP eligibility using the MAGI methodology, use 2013 eligibility policy to determine medical eligibility.
If the individual passes for Medicaid using 2013 eligibility policy, continue eligibility through March 2014 and re-determine eligibility for April 1, 2014 using MAGI rules. If the individual passes for CHIP using 2013 rules, continue CHIP under 2013 rules for another 12-month certification period.
Completion of the Review
Send the client a pre-populated review form with the most current information from electronic records. The review form will explain what the client is required to do to complete the review process and the due date for responding. A signature is not required.
If the client responds by the due date, or sometime during the review month, request needed verification from the client. The agency must send a written request and give the client 10 days to provide the verification.
If the client does not return all requested verification by the due date, eligibility ends at the end of the month for which the eligibility agency can give 10-day notice.
The client has three months after the effective closure date to complete the review without having to re-apply. (See B.)
If the agency cannot give 10-day notice before deciding eligibility for a new enrollment period, extend benefits to the following month. This is called the “due process month”. (See 803 for exceptions to 10-day advanced notice.)
Benefits cannot be extended during the eligibility review for a CHIP eligible child who turns age 19 in the review month.
If the client provides all the requested verifications by the verification due date, the eligibility agency proceeds with the eligibility decision.
The agency continues eligibility into the following month (the “due process month”) if needed while it makes a decision.
Do not end or adversely change eligibility until the end of the month for which the eligibility agency can give a 10-day notice. This includes changing CHIP plans from B to C.
If the client provides all requested verification after the due date and before the end of the review month, proceed with the eligibility decision.
The agency continues eligibility into the following month (the “due process month”), if needed, while it makes a decision.
Do not end or adversely change eligibility until the end of the month for which the eligibility agency can give 10-day notice.
If eligibility is continued into the “due process month”, the client must provide verification by the verification due date.
If the client provides verification by the due date, complete the review and send the notice of the eligibility decision. Do not end or adversely change eligibility until the end of the month for which the eligibility agency can give 10-day notice.
If the client fails to provide verification by the due date, close the case and send notice.
If an overpayment investigation determines individuals were not eligible in the review month and a due process month was established, the referral must include the due process month.
Client fails to complete review process
If the case closes because the client fails to complete the review, eligibility ends at the end of the month in which proper notice can be sent. The client has three months from the date of case closure to complete the review without submitting a new application. (If eligibility is extended to the month after the review month, the three month period begins after the second month.)
The benefit effective date is the first day of the month in which the recipient contacts the agency.
There is no retroactive benefit.
The client may request coverage for the 4-day grace period. (701-2)
No interview or application form is required
Eligibility does not continue while the agency makes a decision.
Application processing time applies.
If the client fails to respond within the three months after the case closes for failure to complete the review, require a new application.
Targeted Low-Income Children (During 2014 Only)
When completing reviews in 2014, children eligible for Medicaid on Dec. 31, 2013, who no longer qualify for Medicaid, but have income under 200% of the FPL, are eligible for CHIP.
If the child would not qualify for CHIP because they have other health insurance, the agency shall make them eligible for CHIP for one year. However, the following children would remain ineligible for CHIP:
Children who have access to coverage through a public employee health insurance plan.
Children who are inmates of a public institution.
Children who are patients in an institution for mental disease (IMD).