OBSOLETE POLICY CHIP MANUAL |
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.
A. A CHIP enrollee may lose eligibility before the end of the 12-month certification period in the following situations.
1. An enrollee turns age 19 before the end of the certification period.
2. An enrollee moves out of state or cannot be located.
3. An enrollee enters a public institution.
4. An enrollee dies.
5. An enrollee requests a redetermination of eligibility and becomes eligible for another medical program, such as Medicaid without a spenddown or MWI premium. (See Section 703)
6. An enrollee begins to be covered by a 'creditable' insurance under a group health plan or other health insurance coverage including COBRA.
7. An enrollee becomes eligible to enroll in Medicare.
8. An enrollee becomes covered by the Veterans Administration Health Care System.
9. An enrollee failed to pay their quarterly premium and/or late fee.
10. An enrollee failed to provide verification of access to affordable health insurance when requested with the ex parte review. See 220-4 & 804.
11. The enrollee provides verification that the client has access to affordable health insurance as part of an ex parte review only.
o Eligibility agency must end benefits in the first month in the new certification period that proper notice can be given.
See Section 220-4 for information about what to do when an enrolled child gains access to coverage through an employer's health insurance coverage.
B. When to Allow a Due Process Month
1. Review - if you cannot give 10-day notice before deciding eligibility, extend benefits to the following month. See Sections 704-1 and 803. This month is not part of any certification period.
2. 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.
C. When to Establish a New 12-Month Enrollment Period
1. The enrollment period for CHIP must be re-determined at 12 months. A new 12-month certification period will be established when:
a. A review is completed and ongoing eligibility for CHIP is established.
b. The enrollee requested an income redetermination and they become eligible for a lesser cost CHIP plan (i.e. Plan C to Plan B).
c. A new 12-month certification period may be established during the certification period when a review is completed on another program and all information needed to determine CHIP eligibility is provided and CHIP eligibility does not change to a higher cost plan (Plan B to Plan C).