GenIC #2 - CHIP State Plan Eligibility

Template CA1 – Program Type Designation

Statute: Sections 2101(a)(1); (a)(2) and (a)(3) of the SSA

Regulation: 42 CFR 457.70

INTRODUCTION

Template CA1 must be completed by all States with a CHIP program.

In this template, States provide information about the structure of their program.

BACKGROUND

Title XXI of the Social Security Act authorizes Federal grants to States for provision of child health assistance to uninsured, low-income children. The program is jointly financed by the Federal and State governments and administered by the States. States are given three options for expanding coverage for children:

1. A separate child health insurance program;

2. A Medicaid expansion program; or

3. A combination of these programs.

Separate child health program means a program under which a State receives Federal funding from its title XXI allotment to provide child health assistance through obtaining coverage that meets the requirements of section 2103 of the Act and 42 CFR 457.402.

Medicaid expansion program means a program under which a state receives Federal funding to expand Medicaid eligibility to optional targeted low-income children under title XIX pursuant to 42 CFR 457.70(c).

TECHNICAL GUIDANCE

The State must select from one of the three options provided.

First Option

If the State selects ‘Coverage that meets the requirements for a separate child health program as provided in section 2101(a)(1) of the SSA’, it must then select one of the following options:

• There is one program name for the State's separate child health program

• There is one overarching program name, with individual names for groups or components within the program

If the State selects ‘There is one program name for the State's separate child health program’, it must then enter the program name in the text box provided.

If the State selects ‘There is one overarching program name, with individual names for groups or components within the program’, it must first enter the name of the program (i.e. overarching name), then enter the sub-group/component program name and a description in the text boxes provided. For multiple entries, reselect ‘sub-group/component program name’ until all entries have been made.

Second Option

If the State selects ‘Expanded coverage under the State’s Medicaid plan utilizing Title XXI funds as provided in section 2101(a)(2) of the SSA’, it must then select one of the following options:

• There is one program name for the State's Medicaid Expansion coverage

• There is one overarching program name, with individual names for groups or components within the program

If the State selects ‘There is one program name for the State's Medicaid Expansion coverage’, it must first enter the program name in the text box provided, then select one of the three options listed in the template.

• The program name applies to the all Medicaid children, including the expansion group;

• The program name applies only to the CHIP Medicaid expansion program; or

• Other Description. If selected, a description must be entered.

If the State selects ‘There is one overarching program name, with individual names for groups or components within the program’, it must first enter the name of the program (i.e. overarching name), then enter the sub-group/component program name and a description in the text boxes provided. For multiple entries, reselect ’sub-group/component program name’ until all entries have been made.

Third Option

If the State selects ‘Combination of both of the above as provided in section 2101(a)(3) of the SSA’, it must then select one of the following options:

• There is one overarching program name for both the separate child health program and Medicaid expansion

• There is one overarching program name for both the separate child health program and Medicaid expansion, with individual names for groups or components within the program

• The separate child health program and Medicaid expansion each have a different program name. There are no additional names for subgroups

If the State selects ‘There is one overarching program name for both the separate child health program and Medicaid expansion’, it must then enter the name in the text box provided.

If the State selects ‘There is one overarching program name for both the separate child health program and Medicaid expansion, with individual names for groups or components within the program’, it must first enter the name of the program (i.e. overarching name) and then the individual program name and description in the text boxes provided. For multiple entries, reselect ‘Individual program name’ until all entries have been made.

If the State selects ‘The separate child health program and Medicaid expansion each have a different program name. There are no additional names for subgroups’, it must then enter the name of the separate CHIP and the name of the Medicaid expansion program in the text boxes provided.

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