GenIC #17 (Revision): CHIP State Plan Eligibility

CS23 – Non-Financial Requirements -
Other Eligibility Standards

Statute: 2102(b) and 2110(b)

Regulation: 457.320(a)

INTRODUCTION

This state plan page (fillable PDF) applies to states with separate child health assistance programs.

In state plan page CS23, states specify and provide information about other non-financial eligibility standards, if any, not covered in the remainder of the eligibility section of the state plan, used in the determination of eligibility for CHIP. This state plan page is required only of states which use other non-financial eligibility standards. States that do not use other non-financial eligibility standards, not covered in the remainder of the eligibility section of the state plan, need not submit this page.

BACKGROUND

To the extent consistent with title XXI of the Social Security Act and except as provided at 42 CFR 457.320(b), states may adopt eligibility standards for one or more groups, with the exception of “Children Ineligible for Medicaid due to Loss of Income Disregards” (defined on state plan page CS14). A state may adopt allowable eligibility standards that are related to unique state eligibility rules.

The standards must be approved by CMS and not otherwise prohibited under regulations. See 42 CFR 457.320(b) for a listing of prohibited eligibility standards.

TECHNICAL GUIDANCE

PREREQUISITES:

It is recommended (but not required) that states submit the state plan pages for the covered groups affected by the other non-financial eligibility standards on CS23. However, if a state is newly electing a covered group for the first time, and it is affected by one or more eligibility standards on this state plan page, then the state must also submit the state plan page for the new covered group prior to or concurrently with state plan page CS23.

Review Criteria

For states electing a covered group for the first time which is affected by one or more eligibility standards on this state plan page (CS23), if the state plan page for the new covered group is not approved, state plan page CS23 cannot be approved.

The option of “Other eligibility standards” is displayed for states to select if the state uses other non-financial eligibility standards.

Review Criteria

If the state uses other non-financial eligibility standards, it must select this option.

For each standard, the state enters a name for the standard in the text box displayed for this purpose. The state then selects the covered group or groups to which the standard applies and also provides a description of how the standard affects eligibility.

Review Criteria

The state must enter a name for each eligibility standard it uses. For each eligibility standard entered, the state must select the covered groups to which the standard applies and also enter a description of how the standard affects eligibility or this state plan page cannot be approved.

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.

If the state has more than one additional eligibility standard, the state can click on the “Add” button and repeat the process until all the standards have been entered. To delete an eligibility standard, the state can click on the “Remove” button to the right of the eligibility standard name.

Note: Although the “Remove” button appears on the same line as the eligibility standard name, it applies to each standard as a whole, that is, when the state clicks on the “Remove” button, in addition to the name of the standard, the eligibility groups selected and the description entered for that eligibility standard all disappear from the page.

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