CMS-10398 #17 Non-Financial Eligibility – Residency

CHIP Eligibility
OMB Control Number: 0938‐1148

Separate Child Health Insurance Program
Non-Financial Eligibility - Residency

CS17

42 CFR 457.320
Residency
The CHIP Agency provides CHIP to otherwise eligible residents of the state, including residents who are absent from the state under
certain conditions.
A child is considered to be a resident of the state under the following conditions:
■

A non-institutionalized child, if capable of indicating intent and who is emancipated or married, if the child is living in the
state and:
1. Intends to reside in the state, including without a fixed address, or
2. Has entered the state with a job commitment or seeking employment, whether or not currently employed.

■

A non-institutionalized child not described above and a child who is not a ward of the state:
1. Residing in the state, with or without a fixed address, or
2. The state of residency of the parent or caretaker, in accordance with 42 CFR.435.403(h)(1), with whom the individual
resides.

■

An institutionalized child, who is not a ward of the state, if the state is the state of residence of the child's custodial parent or
caretaker at the time of placement, or

■

A child who is a ward of the state regardless of where the child lives, or

■

A child physically located in the state when there is a dispute with one or more states as to the child's actual state of
residence.

If the state covers pregnant women, a pregnant woman is considered to be a resident under the following conditions:
■

A non-institutionalized pregnant woman who is living in the state and:
1. Intends to reside in the state, including without a fixed address, or if incapable of indicating intent, is living in the state, or
2. Entered with a job commitment or seeking employment, whether or not currently employed.

■

An institutionalized pregnant woman placed in an out-of-state-institution, as defined in 42 CFR 435.1010, including foster
care homes, by an agency of the state, or

■

An institutionalized pregnant woman residing in an in-state-institution, as defined in 42 CFR 435.1010, whether or not the
individual established residency in the state prior to entering the institution, or

■

A pregnant woman physically located in the state when there is a dispute with one or more states as to the pregnant woman's
actual state of residence.

The state has in place related to the residency of children and pregnant women (if covered by the state):

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CHIP Eligibility
One or more interstate agreement(s).

A policy related to individuals in the state only for educational purposes.

PRA Disclosure Statement
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a
valid OMB control number. The valid OMB control number for this information collection is 0938-1148 (CMS-10398 #17). The time
required to complete this information collection is estimated to average 50 hours per response, including the time to review instructions,
search existing data resources, gather the data needed, and complete and review the information collection. If you have comments
concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard,
Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.

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