CHIP Administration & Eligibility

Template CS33 – General Eligibility - Express Lane Agencies

Statute: Sections 2107(e)(1)(E) and 1902(e)(13) of the SSA

Regulation:

INTRODUCTION

To be completed by States with separate child health assistance programs which elected the option to use Express Lane agencies to determine whether a child meets one or more of the requirements for CHIP eligibility in template CS32.

Template CS33 is used in conjunction with CS32 Express Lane Eligibility. States use this template to designate which agencies will be used by the State as Express Lane Agencies.

BACKGROUND

See implementation guidance for template CS32 for Background Information.

TECHNICAL GUIDANCE

PREREQUISITE: States must have completed template CS32 through the Express Lane Agencies section within which this template gets displayed.

In this template, the State indicates which types of agencies it uses to determine eligibility under the Express Lane option. It must select one or more of the four options listed.

• If ‘Public agencies that determine eligibility for assistance under any of the following’ is selected, the State must check off one or more of the public agencies from the list provided.

• If ‘Other State-specified governmental agency that has fiscal liability or legal responsibility for the accuracy of the eligibility determination findings relied on by the State.’ is selected, the State must provide the name of the agency or agencies. If there are multiple agencies, each agency must be entered separately. This is done by re-checking the box next to the field named ‘Agency Name’.

• If ‘A public agency that is subject to an interagency agreement limiting disclosure and use of the information disclosed for the purposes of determining eligibility under the Plan’ is selected, the State must provide the name of the agency. If there are multiple agencies, each agency must be entered separately. This is done by re-checking the box next to the field named ‘Agency Name’.

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