CHIP Administration & Eligibility

Template CS25 – General Eligibility - Beginning Date of Eligibility

Statute:

Regulation: 42 CFR 457.340(f)

INTRODUCTION

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

In template CS25, States provide information as to the methodology used in determining the effective date of eligibility.

BACKGROUND

With the issuance of Final Rule Vol. 77, No 57, implementing provisions of the ACA, 42 CFR 457.340(f) was revised to require that States have a methodology for determining effective date of eligibility that includes a coordinated transition of children between CHIP and other insurance affordability programs to avoid gaps in coverage.

TECHNICAL GUIDANCE

This template is broken down into the following sections:

Assurance

Determination of Beginning Date of Eligibility

Exceptions

Assurance

Template CS25 begins with the State being asked to provide an assurance that it has a method in place to determine the eligibility and/or enrollment effective dates that ensures coordination between all the insurance affordability programs and avoids gaps or overlap in coverage, including when changes in family circumstances lead to a change in programs.

The State provides this affirmative assurance by checking the box next to the assurance statement. If the State does not check this box, the system will not accept this template for review and approval.

Determination of Beginning Date of Eligibility

The State must select from the 5 options listed as to how it determines the beginning date of eligibility. Only one option may be selected.

If the State selects ‘Prospective effective date”, it must provide a description in the text box provided. The description must include an explanation of the factors considered in determining the prospective effective date, e.g. application date, eligibility determination date, health plan selection and or health plan enrollment.

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.

If the State selects ‘Other‘, it must provide a description in the text box provided. The description must include an explanation of the date (e.g. 15^th of the month, any time during the month), other factors considered (e.g. effective date of loss of coverage prior to application) and rationale (e.g. avoid gaps in coverage).

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.

Exceptions

In this section, the State is asked to describe any exceptions to the CHIP Agency's general rules for beginning dates of eligibility.

The State can skip this section if it does not allow any exceptions. If the State’s policy allows exceptions to the general rules indicated in the previous section, then the State must enter a description of its exception process along with a listing of acceptable exceptions.

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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