OBSOLETE POLICY CHIP MANUAL |
Children may be added to an open CHIP case at any time during the certification period without requiring a new application.
The child must meet all CHIP eligibility factors.
All children being added must be screened for Medicaid eligibility, before they can be added to the CHIP coverage. If the child is eligible for Medicaid, they are not eligible to be added to the CHIP household.
A child, who only qualifies for Medicaid by paying a monthly spenddown and chooses not to meet the spenddown each month, may be added to CHIP.
If it is clear that the applicant does not meet the requirements for Medicaid, do not request any verification that does not apply to CHIP enrollment.
If the child is eligible for CHIP, add the child for the remainder of the certification period.
If the new child’s countable income is over the income limit for CHIP, the agency will transfer the electronic record to the Federally Facilitated Marketplace (FFM) for that child.
Children who have been receiving CHIP and change to a new CHIP household cannot receive CHIP benefits in both households during the same month.
Add the child or children to the new household the first day of the month after they have been removed from the previous CHIP household.
CHIP should not be approved in the same month Medicaid has already issued.
Effective Date of Enrollment
Newborn child: The effective date of enrollment for the child is the date of birth if the family requests the coverage within 30 days of the birth. If the request is made more than 30 days after the birth, the effective date of coverage is the date they report the birth
Newly adopted child: The effective date of enrollment for the child is the date the adoption was finalized if the family requests the coverage within 30 days of the adoption. If the request is made more than 30 days after the adoption was finalized, the effective date of coverage is the date they report the adoption was finalized.
Child placed for adoption: The effective date of enrollment is the date of placement if the request to add the child is made within 30 days of the date of placement. If the request is made more than 30 days after the date of placement, the effective date is the date of the request. These children are first screened for Medicaid.
Child who lose Medicaid Coverage: The effective date of enrollment is the day after the Medicaid ends.
Other Children:
The effective date of enrollment is the first day of the month the household requests coverage for other children. See Section 701-2.
The effective date of enrollment for children being re-opened in conjunction with a new application when the family pays their outstanding quarterly premiums, is the same date as the additional child. (See section 701-1 and 702 for more information.)
Medicaid Screening
It is not necessary to do a new income determination when screening for Medicaid.
If Medicaid screening shows the additional child may be Medicaid eligible, request needed verifications including current income and then take the following action:
Current income is provided and the child meets all factors of Medicaid eligibility - add the child to Medicaid. Any other children in the household who are eligible for Medicaid, must be removed from CHIP and opened for Medicaid.
Current income is provided and the child does NOT meet Medicaid income eligibility - Add the child to CHIP.
Do NOT use the new income or change the certification period if the income has increased and changes the CHIP plan from Plan B to Plan C.
Use the newly verified income and begin a new certification period if income has decreased and changes the plan from Plan C to Plan B.
Current income verification is not provided - Deny Medicaid for the additional child and do not add the child to CHIP.
If Medicaid screening shows that the additional child is NOT Medicaid eligible, add the child to the current CHIP plan if the child is eligible for CHIP.
Adding a Child Increases the Household Size
After adding a child to CHIP, the household size change may result in a change in the plan level. Before the plan level can be changed, current household income must be requested for a new income determination.
Leave the CHIP case open and take no further action if:
Current income is not provided; OR
Current income is provided and the income best estimate increase changes the eligible individuals from Plan B to Plan C. Post the new income best estimate.
Begin a new certification period starting the next possible issuance month and post the new income best estimate if current income is provided and the new best estimate remains the same or is lower and the individual(s) are now eligible for Plan B. (IE: plan C to plan C; plan B to plan B; plan C to plan B.)
Check eligibility factors for all household members.