CHIP State Plan Eligibility

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CHIP Eligibility
OMB Control Number: 0938-1148

State Name:
Transmittal Number:

-

-

Incarcerated CHIP Beneficiaries

CS31

2102(d) and 2110(b)(7) of the SSA
Targeted Low-Income Children Who Become Incarcerated
The state assures that it does not terminate eligibility for children enrolled in a separate CHIP because the child is an inmate of a
public institution.
States may either suspend CHIP coverage or continue to provide CHIP state plan (or waiver of such plan) services otherwise not covered
by the carceral facility to children who are incarcerated. States that elect to suspend CHIP coverage for the duration of a child’s
incarceration may implement a benefits or eligibility suspension.
The state elects to suspend CHIP coverage for the duration of a child’s incarceration:
Yes

No

If yes, then check an option below:
Benefits suspension
Eligibility suspension
The state assures that it redetermines eligibility for any child prior to their release if it has been longer than 12 months since the
child’s last redetermination and restores coverage for child health assistance to eligible children upon their release.
Within the 30 days prior to release (or within one week of release, or as soon as practicable after release), the state assures that it
provides eligible children with any screenings, diagnostic services, or case management services that would otherwise be available to
children under the CHIP state plan (or waiver of such plan).
Additional information regarding implementation of mandatory provisions of section 5121 of the Consolidated Appropriations Act, 2023
(CAA, 2023), including providing screenings, diagnostic services, or case management services:

Under section 5122 of the CAA, 2023, states may consider otherwise eligible children who are inmates pending disposition of charges as
eligible for CHIP and provide all services covered under the CHIP state plan.
The state elects to provide all CHIP state plan benefits (or waiver of such plan) to eligible children who are inmates pending
disposition of charges.

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. 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.
V.20251202

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CHIP Eligibility
Children Determined Eligible for CHIP While Incarcerated
Generally, children who apply for CHIP when they are in a carceral facility are not eligible because of the eligibility exclusion for inmates
of a public institution under section 2110(b) of the Act. However, section 2110(b)(7) of the Act provides an exception to this eligibility
exclusion for children who are within 30 days prior to their release.
The state assures that it will process any application submitted by or on behalf of a child and make an eligibility determination for
child health assistance to provide all services available under the CHIP state plan (or waiver of such plan) upon their release from the
institution.
Children who apply and are found eligible within 30 days prior to their release will be provided screening and diagnostic services, and
case management services that are otherwise available under the CHIP state plan (or waiver of such plan).
Targeted Low-Income Pregnant Women Who Become Incarcerated
The state assures that it does not terminate eligibility for pregnant women enrolled in a separate CHIP because the pregnant woman is
an inmate of a public institution.
States may either suspend CHIP coverage or continue to provide CHIP state plan (or waiver of such plan) services otherwise not covered
by the carceral facility to pregnant women who are incarcerated. States that elect to suspend CHIP coverage for the duration of a pregnant
woman’s incarceration may implement a benefits or eligibility suspension.
The state elects to suspend CHIP coverage for the duration of a pregnant woman’s incarceration:
Yes

No

If yes, then check an option below:
Benefits suspension
Eligibility suspension

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. 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.
V.20251202

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