Implementation Guides

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CS17 - Non-Financial – Residency
Statute: 2102(b)(1)(A)
Regulations: 42 CFR 457.320(d)

INTRODUCTION

To be completed by states with separate child health assistance programs.
Screen CS17 highlights specific requirements as to what constitutes residency, along with
soliciting information from states regarding their policies for individuals who are temporarily out
of the state or temporarily living in the state.

BACKGROUND

The definition of who is considered a resident of the state takes into consideration certain
conditions that must be met and criteria to be used to determine the residency of individuals who
are not able of indicating intent; are institutionalized or may be absent from the state.
Regulatory changes in final rule published on March 23, 2012 (77 FR 17206), implementing
several provisions of the ACA, sought to simplify and clarify residency rules and to align those
rules with those that will apply under other insurance affordability programs.
CHIP residency regulations were revised to align with the Medicaid residency rules, including:
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42 CFR 435.403(i) - Residency for a non-institutionalized child who is not a ward of the
state;

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42 CFR 435.403(h) - Residency for targeted low-income pregnant woman; and

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42 CFR 435.403(m) – Handling of cases of disputed residency.

For non-institutionalized adults, simplification and clarification included removal of the term
“permanently or for an indefinite period” from the residency definition; replacement of the term
“intention to remain” with “intends to reside, including without a fixed address” and the addition
of “inclusion of individuals who have entered the state with a job commitment or are seeking
employment (whether or not currently employed)” in re-designated 435.403(h).
For children, simplification and clarification included consolidation of two previously existing
definitions of residency (that of disabled children with nondisabled, non-institutionalized, nonIV–E foster care/adoption assistance children) in re-designated 435.403(i)(2) and the application
of adult residency rules to children, capable of indicating intent, who are emancipated or,
married.

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CS17 - Non-Financial – Residency
To address concerns of retention and gaps in coverage of children who, because of migration of
families, emergency evacuations, natural or other disasters, public health emergencies,
educational needs, or otherwise, frequently change their state of residency or otherwise are
temporarily located outside of their state of residency, CMS has proposed a model process for
interstate coordination in accordance with section 213 of the Children’s Health Insurance
Program Reauthorization Act (CHIPRA). The model process may be found at External Link:
Interstate Coordination Model Process.

TECHNICAL GUIDANCE
PREREQUISITES:
None
This screen is broken down into the following sections:
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Assurance
Residency for Children
Residency for Pregnant Women, if applicable
Interstate Agreement

Assurance
Screen CS17 begins with the state providing assurance that it meets the requirement of providing
CHIP to otherwise eligible residents of the state.
The state provides this affirmative assurance by checking the box next to the assurance
statement.
Review Criteria
The state must check the assurance box or this state plan page cannot be approved.
Residency for Children
This section includes a list of conditions under which children are considered to be residents of
the state. Since these are required of all states with separate CHIP programs, they are prechecked and do not require any entry by the state.

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CS17 - Non-Financial – Residency
Residency for Pregnant Women
This section applies only to states which also cover targeted low-income pregnant women under
section 2112 of the SSA. States which do not cover targeted low-income pregnant women may
ignore this section. Use of this state plan page does not imply coverage of, or commit a state to
cover, targeted low-income pregnant women.
This section includes a list of conditions under which pregnant women are considered to be
residents of the state. Since these are required of all states with separate CHIP programs, they are
pre-checked and do not require any entry by the state.
Interstate Agreement
This section applies to both children and pregnant women, if the state also covers pregnant
women.
This section begins with a Yes/No question for the state to indicate whether the state has in place
one or more interstate agreements related to residency.
Review Criteria
The state must select either yes or no or this state plan page cannot be approved.
If the response is yes, the state:
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Selects the states, from the list provided, with which it has interstate agreements; and
Selects the categories of individuals which are included in the interstate agreements from
the list provided. If a category of individuals included in the interstate agreement is not
on the list, the state selects the box for “Other type of individual” and enters a name and
description of the other type of individual. If there is more than one other type of
individual the state checks the box next to the last entry of “Name of Type” and repeats
the process until they are all entered.
Review Criteria

The state must select one or more of the states listed and also select one or more of the
categories of individuals included in interstate agreements or this state plan page cannot
be approved. If the state selects “Other type of individual”, the state must also enter a
name and description of the type of individual or this state plan page cannot be approved.
The description entered by the state 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.
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CS17 - Non-Financial – Residency
This is followed by another Yes/No question asking if the state has a policy related to individuals
who are in the state only for educational purposes.
Review Criteria
The state must select either yes or no or this state plan page cannot be approved.
If the response is yes, the state must provide a description of the policy. Examples of what may
be included in the policy include:
• That these individuals are considered as being in the state temporarily and therefore are
not considered to be residents of the state; or
• That they are considered to be residents if they are in the state for a specified length of
time (e.g. not less than 90 days).
If the policy varies depending on the state with which there is an interstate agreement, the state
should note the differences here.
Review Criteria
The state must enter a description 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.

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