GenIC #2 - CHIP State Plan Eligibility

Template CS21 Non-Financial – Non-Payment of Premiums

Statute: 2103(e)(3)(C)

Regulation: 42 CFR 457.510 and 570

Additional references: SHO # 10-001, dated January 22, 2010

INTRODUCTION

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

In this template, States provide information about their policies and procedures with respect to non-payment of premiums.

BACKGROUND

When a State imposes premiums or other cost-sharing, the State plan must describe the consequences of non-payment of those charges in their State plan.

Section 504 of CHIPRA amends the cost-sharing provisions at section 2103(e)(3) of the Social Security Act (the Act) by adding a requirement that States grant individuals enrolled in separate child health programs, a 30-day grace period, from the beginning of a new coverage period, to pay any required premium before enrollment may be terminated. The new coverage period begins with the month following the last period for which a premium was paid. Additional information may be found in SHO # 10-001, dated January 22, 2010.

TECHNICAL GUIDANCE

This template begins with a Y/N question as to whether the State imposes premiums.

If the answer is no, the State is not asked any additional questions on this topic.

• If the answer is yes, States are asked another Y/N question ‘Does the State have a premium lock out period?’

If the answer is yes, the State must provide a description in the text box provided. The description should include:

• Whether payment is required for all past-due months or if any portion of the past-due payment may be forgiven,

• A description of the overdue payment notification process along with the number of months which could potentially be overdue before eligibility is terminated,

• Whether it applies until the child’s premium is paid or whether it continues after the premium has been paid.

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.

The State is then asked ‘What is the length of the time premium lock-out period?’

The State selects the applicable time period from the displayed list. If the applicable time period is not on the list, the State selects other and enters the time period in the description box provided.

Note: States selecting ‘Other’ should enter a number and the time period to which that number applies, e.g. 100 days, 6 months along with any other relevant information.

2