GenIC #17 (Extension w/o change): CHIP State Plan Eligibility

Generic Clearance for Medicaid and CHIP State Plan, Waiver, and Program Submissions (CMS-10398)

OMB: 0938-1148

IC ID: 229614

Documents and Forms

Document Name Document Type
Form CMS-10398 #17 GenIC #17 (Extension w/o change): CHIP State Plan Eligibility Form
CMS-10398 #17 CS3 - Eligibility for Medicaid Expansion Program CS3.jpg Form
CMS-10398 #17 CS8 - Eligibility - Targeted Low-Income Pregnant Women CS8.jpg Form
CMS-10398 #17 CS9 - Eligibility - Coverage From Conception to Birth CS9.jpg Form
CMS-10398 #17 CS10 - Eligibility - Children Who Have Access to Public CS10.pdf Form
CMS-10398 #17 CS11 - Eligibility - Pregnant Women Who Have Access to P CS11.pdf Form
CMS-10398 #17 CS12 - Eligibility - Dental Only Supplemental Coverage CS12.pdf Form
CMS-10398 #17 CS13 - Eligibility - Deemed Newborns CS13.jpg Form
CMS-10398 #17 CS14 - Eligibility - Children Ineligible for Medicaid as CS14.pdf Form
CMS-10398 #15 CS15 - MAGI-Based Income Methodologies CS15.pdf Form
CMS-10398 #17 CS16 - Other Eligibility Criteria - Spenddowns CS16.pdf Form
CMS-10398 #17 CS17 - Non-Financial Eligibility – Residency CS17.pdf Form
CMS-10398 #17 CS19 - Non-Financial Eligibility - Social Security Numbe CS19.pdf Form
CMS-10398 #17 CS20 - Non-Financial Eligibility - Substitution of Cover CS20.pdf Form
CMS-10398 #17 CS21 - Non-Financial Eligibility - Non-Payment of Premiu CS21.pdf Form
CMS-10398 #17 CS23 - Non-Financial Requirements - Other Eligibility St CS23.pdf Form
CMS-10398 #17 CS24 - General Eligibility - Eligibility Processing CS24.pdf Form
CMS-10398 #17 CS27 - Non-Financial Requirements - Other Eligibility St CS27.pdf Form
CMS-10398 #17 CS28 - General Eligibility - Presumptive Eligibility for CS28.pdf Form
CMS-10398 #17 CS29 - General Eligibility - Presumptive Eligibility for CS29.pdf Form
CMS-10398 #17 CS7 - Eligibility - Targeted Low-Income Children IG_CS7 - Targeted Low-Income Child_R1_Final_11-30-12.docx Form
17 - Final Supporting Statement CHIP State Plan Eligibility.docx #17 - Supporting Statement IC Document