CHIP Administration & Eligibility

Template CS5 – Completion of Covered Groups

Statute: N. A.

Regulation: N. A.

INTRODUCTION

To be completed by States with Separate CHIP programs.

PREREQUISITE:  States must complete the Separate CHIP Options template CS4 prior to completing this template.

Template CS5 is used as a jumping off point for states to enter eligibility information with respect to the covered groups for the State’s separate child health assistance program. This is done for the initial submission of the plan and whenever a covered group is added by the state. Based on the selections made in template CS5, states will also need to complete the corresponding covered group templates (CS7 – CS14).

BACKGROUND

Section 2102(a)(5) of the SSA and 42 CFR 457.305(a) require the inclusion of eligibility standards in the CHIP State Plan. This template allows access to the covered groups templates for states to enter their state’s eligibility standards, with the exception of some non-financial standards covered in other templates, for the groups covered by the State.

TECHNICAL GUIDANCE

This template displays a list of the covered groups selected by the CHIP Agency in template CS4. The CHIP agency is asked to select one or more from this list which require completion for the first time. The covered group templates corresponding to the selection(s) made will display for completion.

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