CHIP Administration & Eligibility

Template CA3 – Organization and Administration

Statute:

Regulation:

INTRODUCTION

Template CA3 must be completed by all States with a CHIP program.

In this template, the State provides a description of the organization and functions of the CHIP agency and the staff making eligibility decisions for the separate CHIP program.

BACKGROUND

TECHNICAL GUIDANCE

There are two parts to template CA3.

In the first part, States must provide a description of the organization and functions of the CHIP agency in the text box provided.

Review Criteria

The description should be sufficiently clear, detailed and complete to permit the reviewer to determine that the State’s organizational structure provides adequate support for the administration and operation of the State’s child health assistance program.

Then the State must attach an organizational chart of the CHIP agency via the upload function.

PREREQUISITE: Template CA2 (Designation and Authority) must have been completed before completing the second part of the template. This part displays only for States which indicated in CA2 (Designation and Authority) that eligibility decisions are made by other than the CHIP agency or the CHIP agency plus other agencies.

States utilizing other entities to make CHIP eligibility decisions must provide a description of the staff designated by those other agencies and the functions they perform in carrying out their responsibility.

Review Criteria

The description should be sufficiently clear, detailed and complete to permit the reviewer to determine that the staffing and the functions they provide adequately support the determination of eligibility and related functions.