CHIP Administration & Eligibility

Template CS23 – Non-Financial Requirements - Other Eligibility Standards

Statute: Sections 2102(b) and 2110(b)

Regulation: 457.320(a)

INTRODUCTION

To be completed by States with separate child health assistance programs.

In template CS23 States specify and provide information about other eligibility standards used in the determination of eligibility for CHIP.

BACKGROUND

This template provides States with the opportunity to include additional eligibility standards in their plan, provided that the standards are approved by CMS and not otherwise prohibited under regulations. To the extent consistent with title XXI of the Act and except as provided at 457.320(b) of this section, the State plan may adopt eligibility standards for one or more groups of children related to:

(1) Geographic area(s) served by the plan;

(2) Age (up to, but not including, age 19);

(3) Income;

(4) Resources;

(5) Spenddowns;

(6) Disposition of resources;

(7) Residency, in accordance with paragraph (d) of this section;

(8) Disability status, provided that such standards do not restrict eligibility;

(9) Access to, or coverage under, other health coverage; and

(10) Duration of eligibility, in accordance with paragraph (e) of this section.

See 42 CFR 457.320 (b) for a listing of prohibited eligibility standards.

TECHNICAL GUIDANCE

The option of ‘other eligibility standards’ is displayed.

If the State has other eligibility standards, it must check the box next to this option.

If the State selects this option, it must then provide a name for the standard in the text box displayed for this purpose.

After the State has entered the name of the standard, the State must select the covered groups to which this standard applies from a dropdown list of covered groups under the State’s plan.

After the covered groups have been selected, the State must describe how this standard affects eligibility in the text box displayed for this purpose.

If the State has more than one additional eligibility standard, it can repeat this process by re-selecting the box next to the ‘other eligibility standards’ option.

Review Criteria

The description should be sufficiently clear, detailed and complete to permit the reviewer to determine that the State’s election meets applicable federal statutory, regulatory and policy requirements.

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