Document Name Document Type
Form CMS-10434 (#2) GenIC #2 - CHIP State Plan Eligibility Form
#2 - IG_CA1 - Program Type Designation_R1_Final_ 11-30-12.docx Instruction
#2 - IG_CA2 - Designation and Authority_R1_Final_11-30-12.docx Instruction
#2 - IG_CA3- Organization and Administation_R1_Final_ 11-30-12.docx Instruction
#2 - IG_CA4 - CHIP State Plan Administration-Assurances_R1_Draft_11-30-12.docx Instruction
#2 - IG_CHIP Admin Introduction_R1_Final_11-30-12.docx Instruction
#2 - IG_CHIP Eligibility Introduction_R1_Final_11-30-12.docx Instruction
#2 - IG_CS3 - Medicaid Expansion_R1_Final_11-30-12.docx Instruction
#2 - IG_CS4 - Separate CHIP Covered Groups_R1_Final_11-30-12.docx Instruction
#2 - IG_CS5 - Completion of Covered Groups_R1_Final_11-30-12 .docx Instruction
#2 - IG_CS6 - Income Standards_R1_Final_11-30-12.docx Instruction
#2 - IG_CS7 - Targeted Low-Income Child_R1_Final_11-30-12.docx Instruction
#2 - IG_CS8 - Targeted Low-Income Pregnant Women_R1_Final_ 11-30-12.docx Instruction
#2 - IG_CS9 - Coverage from Conception to Birth_R1_Final_11-30-12.docx Instruction
#2 - IG_CS10- Children with Access to Public Employee Coverage_R1_Draft_11-30-12.docx Instruction
#2 - IG_CS11 - Pregnant Women Who Have Access to Public Employee Coverage_R1_Draft_11-30-12.docx Instruction
#2 - IG_CS12 - Dental Only Supplemental Coverage_R1_Final_ 11-30-12.docx Instruction
#2 - IG_CS13 - Deemed Newborns_R1_Draft_11-30-12.docx Instruction
#2 - IG_CS14 - Children Inelig for Medicaid as a Result of the Elim of Income Disregards_R1_Final_11-30-12.docx Instruction
#2 - IG_CS15 - MAGI-Based Income Methodologies_R1_Final_11-30-12.docx Instruction
#2 - IG_CS16 - Spenddown_R1_Final_11-30-12.docx Instruction
#2 - IG_CS17 - Non-Financial-Residency_R1_Final_11-30-12.docx Instruction
#2 - IG_CS18 - Non-Financial-Citizenship_R1_Final_11-30-12.docx Instruction
#2 - IG_CS19 - Non-Financial-Social Security Number_R1_Draft_11-30-12.docx Instruction
#2 - IG_CS20 - Non-Financial-Substitution of Coverage_R1_Draft_11-30-12.docx Instruction
#2 - IG_CS21 - Non-Financial-Non-Payment of Premiums_R1_Draft_11-30-12.docx Instruction
#2 - IG_CS22 - Non-Financial Requirements_R1_Draft_11-30-12.docx Instruction
#2 - IG_CS23 - Non-Financial Requirement-Other Eligibility Standards_R1_Final_11-30-12.docx Instruction
#2 - IG_CS24 - Eligibility Processing_R1_Final_11-30-12.docx Instruction
#2 - IG_CS25 - Beginning Date of Eligibility_R1_Final_11-30-12.docx Instruction
#2 - IG_CS26 - Ending Dates of Eligibility_R1_Final_11-30-12.docx Instruction
#2 - IG_CS27 - Continuous Eligibility_R1_Final_11-30-12.docx Instruction
#2 - IG_CS28 - Presumptive Eligibility for Children_R1_Draft_11-30-12.docx Instruction
#2 - IG_CS29 - Presumptive Eligibility for Pregnant Women_R1_Draft_11-30-12.docx Instruction
#2 - IG_CS30 - Qualified Entities_R1_Final_11-30-12.docx Instruction
#2 - IG_CS32 - Express Lane Eligibility_R1_Final_11-30-12.docx Instruction
#2 - IG_CS33 - Express Lane Agencies_R1_Final_11-30-12.docx Instruction
#2 - IG_CS34 - Express Lane Eligibility Components_R1_Final_11-30-12.docx Instruction
CMS-10434 (#2) CHIP Admin GenIC #2 Screen Shots - CHIP Admin.pdf Form
CMS-10434 (#2) CHIP Eligibility GenIC #2 Screen Shots - CHIP Eligibility.pdf Form
GenIC # 2 - Supporting Statement CHIP Templates [rev 03-28-2016 by OSORA PRA].docx GenIC #2 - Supporting Statement (CHIP State Plan Eligibility) IC Document

            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.