CHIP Administration & Eligibility

Template CS3 – Medicaid Expansion

Statute: Section 2101(a)(2)

Regulation: 42 CFR 457.320(a)(2) and (3)

INTRODUCTION

To be completed only by States which have a Medicaid Expansion program.

In this template states provide the qualifying ages for children and the income eligibility standards the state uses for determining eligibility under its Medicaid expansion program.

BACKGROUND

One of the options states have to provide child health assistance to uninsured, low-income children using CHIP funding, is via an expansion of their Medicaid program. States may choose to offer child health assistance solely under a Medicaid expansion or in combination with coverage offered under a separate program.

Under this option states can expand coverage to children who do not qualify for Medicaid under the State’s income rules in effect as of March 31, 1997. States establish the qualifying income limits to be used under this option. All other Medicaid rules under the State’s Medicaid plan apply.

The same financial requirements (income restrictions) applicable to a separate child health program also apply to a Medicaid expansion.

This option applies only to targeted low-income children and cannot be used for coverage of pregnant women.

TECHNICAL GUIDANCE

Template CS3 must be completed by states offering coverage to targeted low-income children through an expansion of Medicaid or a combination of a Medicaid expansion and separate CHIP. This template displays only for states with a Medicaid expansion program.

States are asked to first provide the age range to which a qualifying income standard applies and then to enter the income range that applies to that age range.

For age, the screen displays ‘From Age’ and ‘Up to Age’ fields with dropdown boxes of a list of ages, zero through 19, from which the state can select.

Note to CMS: I need to confirm with Northrup Grumman as to whether they used zero or birth and will revise accordingly.

Where income standards are requested, a grid is displayed with the following fields:

Two fields for age, labeled ‘From Age’ for the lower end of the age range and ‘Up to Age’ for the upper bound of the age range. States select the ages from a dropdown list with values from 0 to 19.

Note: The ‘From Age’ includes the child’s birthday. The Up to Age should be read as ‘up to be but not including’. That is, for example, up to age 6 means until the child’s sixth birthday but not including the child’s birthday.

Two fields for percentage of Federal poverty level (FPL) labeled ‘Above’ for the lower end of the income standard and ‘Up to and including’ for the upper bound of the income standard. The State enters in the FPL amounts in both fields.

Note: The ‘above’ amount does not equal the actual dollar amount represented by the FPL percentage entered, but rather is equal to the dollar amount plus one cent of the FPL percentage entered. However, ‘up to and including’ is inclusive of the actual dollar amount represented by the FPL percentage entered. Example: for income range of above 185% (dollar value = $1,850) up to and including 250% (dollar value = $2,500), the lower end equals $1,850.01 and the upper end equals $2,500 exactly). To avoid gaps, after the State has entered in the first income standard, the amount entered for the ‘above’ value for the subsequent income standard should equal the previous ‘up to and including’.

The age and income grid may be completed in two ways:

1. By first entering in an age range and then the income range that applies to that age range. This process would get repeated until all the age and income ranges are entered, or

2. Entering all the individual age ranges first. By doing this, a list of the ages gets created on the left hand side of the grid. The income ranges would then be entered in the columns next to each individual age range.

Age Validation 1: checks the first entry for ‘up to’ age to ensure that it does not equal zero. If the validation fails, an error message is displayed and the state is given the opportunity to correct.

Age validation 2: checks to make sure that the 'Up to' value is greater than the 'From' value. If the validation fails, an error message is displayed and the state is given the opportunity to correct.

Note: when selecting multiple age ranges, the second and subsequent ‘From Age’ field is auto-populated with the previous ‘Up to Age’ value. This eliminates gaps in coverage by age group.

Once the State has entered the age range, the system will display income range fields. For income ranges, the State must enter both the lower (above) and upper bounds (up to and including) of the Federal Poverty Level percentages used for the qualifying income limit for the age range entered.

Income validation 1: checks to make sure that the number entered for 'up to and including ' is greater than that entered for 'above'. If the validation fails, entries must be corrected.

Income validation 2: checks to make sure that the number entered for 'up to' is not greater than 300. If a value of greater than 300% is entered, a message will display stating ‘Upper limit cannot exceed 300% FPL’. If the error message displays, the State must correct, the number entered in the ‘'up to and including ' field, before they can proceed.

If the State uses different income standards for different ages, the State can select the fields for the age ranges multiple times until all the age and income ranges used by the State have been entered.

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