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.
Exceptions to the 12-Month Certification Period
A CHIP client may lose eligibility before the end of the 12-month certification period in the following situations.
A client turns age 19 before the end of the certification period.
A client moves out of state or cannot be located.
A client enters a public institution.
A client dies.
A client requests a redetermination of eligibility and becomes eligible for another medical program, such as Medicaid without a spenddown or MWI premium. (See Section 703)
A client begins to be covered by a 'creditable' insurance under a group health plan or other health insurance coverage including COBRA.
A client becomes eligible to enroll in Medicare.
A client becomes covered by the Veterans Administration Health Care System.
A client fails to pay their quarterly premium and/or late fee.
A client fails to provide verification regarding access to employer sponsored health insurance when requested.
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 and 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 will be established when:
A review is completed and ongoing eligibility for CHIP is established.
A client requests an income redetermination and they become eligible for a lesser cost CHIP plan (i.e. Plan C to Plan B).
A client 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.