Mandatory
12-Month Postpartum Continuous Eligibility in CHIP for States
Electing This Option in Medicaid
At
state option in Medicaid, states may elect to provide continuous
eligibility for an individual’s 12-month postpartum period
consistent with section 1902(e)(16) of the SSA. If elected under
Medicaid, states are required to provide the same continuous
eligibility and extended postpartum period for pregnant
individuals in its separate CHIP. A separate CHIP cannot
implement this option if not also elected under the Medicaid state
plan.
State
elected the Medicaid option to provide continuous eligibility
through the 12- month postpartum period Yes/No
If
YES, show rest of the Postpartum Section
□ The
state assures the extended postpartum period available to pregnant
targeted low-income children or targeted low-income pregnant women
under section 2107(e)(1)(J) of the SSA is provided consistent with
the following provisions:
□
Individuals
who, while pregnant, were eligible and received services under the
state child health plan or waiver shall remain eligible throughout
the duration of the pregnancy (including any period of retroactive
eligibility) and the 12-month postpartum period, beginning on the
last day the pregnancy ends and ending on the last day of the 12th
month consistent with paragraphs (5) and (16) of section 1902(e)
of the SSA
□ Continuous
eligibility is provided to targeted low income children who are
pregnant or targeted low-income pregnant women (if applicable) who
are eligible for and enrolled under the state child health plan
through the end of the 12-month postpartum period who would
otherwise lose eligibility because of a change in circumstances,
unless:
□ The
individual or representative requests voluntary disenrollment.
□ The
individual is no longer a resident of the state.
□ The
Agency determines that eligibility was erroneously granted at the
most recent determination or renewal of eligibility because of
Agency error or fraud, abuse, or perjury attributed to the
individual.
□ The
individual dies.
Unlike
continuous eligibility for children, states providing the 12-month
postpartum period may not end an individual’s continuous
eligibility due to non-payment
of premiums or
becoming eligible for Medicaid.
□
Consistent
with section 2107(e)(1)(J) of the SSA, the state assures that
continuous eligibility is provided through an individual’s
pregnancy and 12-month postpartum period regardless of non-payment
of premiums, or
an individual becoming eligible for Medicaid.
□ Benefits
provided during the 12-month postpartum period must be the same
scope of comprehensive services consistent with the benefit
package elected by the state under section 2103(a) of the SSA that
is available to targeted low income children and/or targeted
low-income pregnant women and may include additional benefits as
described in Section 6 of the CHIP state plan.
Mandatory
Continuous Eligibility for Children
The
CHIP Agency must provide that children who have been determined
eligible under the state plan shall remain eligible, regardless of
any changes in the family’s circumstances, for a 12-month
continuous eligibility period.
□
Consistent
with section 2107(e)(1)(K) of the SSA, the state assures that
continuous eligibility is provided to its targeted low-income
children for a duration of 12 months, regardless of any changes in
circumstances, unless:
□ The
child attains age 19.
□ The
child or child's representative requests voluntary disenrollment.
□ The
child is no longer a resident of the state.
□ The
Agency determines that eligibility was erroneously granted at the
most recent determination or renewal of eligibility because of
Agency error or fraud, abuse, or perjury attributed to child or
child's representative.
□ The
child dies.
□ The
child becomes eligible for Medicaid.
□
There
is a failure to pay required premiums or enrollment fees on behalf
of a child, as provided for in the state plan
The
state elects to provide coverage to the
from-conception-to-end-of-pregnancy (FCEP) population (otherwise
known as the “unborn”). Yes/No
If
YES, show rest of the FCEP CE Section
□ The
state assures continuous
eligibility for the FCEP population is provided in the same manner
as continuous eligibility for other targeted low-income children,
except for the duration of the continuous eligibility period.
The
duration of continues eligibility for the FCEP population depends
on whether a state enrolls the birthing parent into Medicaid for
coverage of labor and delivery or pays for the delivery under
CHIP. The state conducts at least one of the following actions
upon birth of the child:
CHIP
pays for labor and delivery and the state screens the child for
potential eligibility for Medicaid. Yes/No
Emergency
Medicaid pays for labor and delivery and the state deems the
newborn eligible for Medicaid and ends the continuous eligibility
period in CHIP. Yes/No
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