Implementation Guides

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CS24 – General Eligibility - Eligibility Processing
Statute: 2102(b)(3) & 2107(e)(1)(O) of the SSA
Regulation: 42 CFR 457, subpart C; 457.110

INTRODUCTION

To be completed by states with separate child health assistance programs.
In state plan page CS24, states provide assurances and information with respect to application
processing, eligibility screening and enrollment in CHIP and other insurance affordability
programs, and redetermination processing for CHIP. This plan page also allows states that wish
to use an alternative application for CHIP to request permission to do so.

BACKGROUND

The ACA requires states to have processes/procedures in place for enrollment simplification and
coordination with state health insurance exchanges and Medicaid. Section 2107(e)(1)(O) of the
Social Security Act requires the application of these requirements to CHIP to the same extent as
they apply to Medicaid under section 1943(b) of the SSA.
These processes/procedures must include the use of a single application for all insurance
affordability programs and the availability of an internet website for use by individuals to apply
for, be enrolled in, and to renew their enrollment in medical assistance (including CHIP);
facilitation of enrollment of individuals who are identified by another insurance affordability
program; coordination for CHIP-eligible individuals who are also enrolled in other health
insurance plans; and outreach to and enrollment of vulnerable and underserved populations
eligible for medical assistance.
States must also participate in and comply with the requirements for the system established by
CMS (under section 1413 of the ACA), relating to streamlined procedures for enrollment
through an Exchange, Medicaid, and CHIP; ensure that individuals who apply for but are
determined ineligible for CHIP or Medicaid are screened for eligibility and enrollment in
qualified health plans and for premium tax credit/cost-sharing reduction without having to
submit an additional or separate application; transfer the electronic application data of
individuals to other insurance affordability programs; participate in a data matching arrangement
for determining individual’s eligibility for CHIP; and that the state Medicaid agency, the state
CHIP agency and the state’s Exchange utilize a secure electronic interface.
State CHIP agencies must enter into an agreement with the Exchange or other agencies
administering other insurance affordability programs to fulfill requirements related to application
screening, coordination of eligibility, secure transfer of data and other requirements consistent
with 42 CFR 457.348(b). State CHIP agencies may also enter into an agreement with the
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CS24 – General Eligibility - Eligibility Processing
Exchange, under which the state CHIP agency may determine eligibility for premium assistance
for the purchase of a qualified health plan; or with the Exchange or Medicaid Agency to accept
CHIP eligibility decisions made by the Exchange or the Medicaid Agency.

TECHNICAL GUIDANCE
PREREQUISITES:
None
This state plan page is broken down into the following sections:
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Assurance
Application Processing
Screen and Enroll Process
Redetermination Processing
Screening by Other Insurance Affordability Programs

Assurance
State plan page CS24 begins with the CHIP Agency being asked to provide assurance that it
meets all of the requirements of 42 CFR 457, subpart C for application processing, eligibility
screening and enrollment.
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.
Application Processing
This section begins with the state being asked to indicate which application(s) the agency uses
for individuals applying for coverage who may be eligible based on the applicable modified
adjusted gross income standard. If a state is requesting approval of an alternative application
(either streamlined or for multiple benefits) it must do so in this state plan page by selecting the
applicable option. The application form(s) for the selected alternative application(s) must also be
attached in order to receive approval from CMS.
The state selects one of the two options displayed.
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CS24 – General Eligibility - Eligibility Processing
Review Criteria
The state must select one of the two application options displayed or this state plan page
cannot be approved.
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If the state selects “An alternative single, streamlined application developed by the state
and approved by the Secretary…” it then attaches a copy of the application for CMS
review.

Please note that the button stating “An attachment is submitted” is an inactive button used as
a reminder for the state to attach a document to the MMDL. Each state plan amendment
submission includes an MMDL screen that provides an upload function for attachments.
Review Criteria
The state must upload the application or this state plan page cannot be approved.
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Once the state has selected at least one of the two options above, a third option “An
alternative application used to apply for multiple human service programs approved by
the Secretary…” is displayed, which the state may select at its option. If the state selects
this option, it must then attach a copy of the alternative application.

Please note that the button stating “An attachment is submitted” is an inactive button used as
a reminder for the state to attach a document to the MMDL. Each state plan amendment
submission includes an MMDL screen that provides an upload function for attachments.
Review Criteria
The state must upload the application or this state plan page cannot be approved.
Next, the state is asked to provide assurance that the agency’s procedures permit the submittal of
an application via the internet website described in CFR 457.340(a), by telephone, via mail, in
person and other commonly available electronic means.
The state provides this affirmative assurance by checking the box next to the assurance
statement.
Review Criteria
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CS24 – General Eligibility - Eligibility Processing
The state must check the assurance box or this state plan page cannot be approved.
If the agency accepts applications by other electronic means (i.e. other than the internet website),
the state checks the box next to the “Other electronic means” option and then enters the name(s)
and description(s) of these other means of accepting applications. Examples of other electronic
means include: by fax or an attachment to an email.
Review Criteria
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.
Screen and Enroll Process
This section begins with the state being asked to provide assurance that it has coordinated
eligibility and enrollment screening procedures in place that are applied at the time of initial
application, periodic redeterminations, and follow-up eligibility determinations.
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.
This assurance is followed by a listing of three procedures which are pre-checked as they are
required of all states.
This is followed by a Yes/No question asking if the CHIP agency has entered into an
arrangement with the Exchange to make eligibility determinations for advanced premium tax
credits in accordance with section 1943(b)(2) of the SSA. Regardless of whether the state
responds with a yes or no to this question, no additional information is required.
Review Criteria
The state must select yes or no or this state plan page cannot be approved.

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CS24 – General Eligibility - Eligibility Processing
Redetermination Processing
This section consists of an assurance that redeterminations of eligibility for individuals whose
financial eligibility is based on the applicable modified adjusted gross income standard are
performed consistent with 42 CFR 457.343. The assurance includes three pre-checked
requirements related to redetermination processing.
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.
Screening by Other Insurance Affordability Programs
This section begins with the state being asked to provide assurance that it has adopted procedures
to accept and process electronic accounts of individuals screened as potentially eligible for CHIP
by other insurance affordability programs in accordance with the requirements of 42 CFR
457.348(b) and to determine eligibility in accordance with 42 CFR 457.340 in the same manner
as if the application had been submitted directly to, and processed by, 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.
The following option appears immediately after the assurance: “The CHIP agency elects the
option to accept CHIP eligibility decisions made by the Exchange or other agencies
administering insurance affordability programs as provided in 42 CFR 457.348 and to furnish
CHIP in accordance with requirements of 42 CFR 457.340 to the same extent and in the same
manner as if the applicant had been determined by the state to be eligible for CHIP.”
If the state checks this option, the state then selects from three options displayed to specify from
which agency(ies) it will accept eligibility determinations. One, two or all three of the options
may be selected.
Review Criteria
The state must select at least one of the options or this state plan page cannot be approved.
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CS24 – General Eligibility - Eligibility Processing
If the state selects “Other agency administering insurance affordability programs”, it then enters
the name(s) of the agency or agencies.
Review Criteria
The names of the agencies entered must accurately reflect the names of the agencies,
authorized to determine eligibility for insurance affordability programs, with whom the state
has entered into an agreement.
The last part of this section asks the Agency to provide assurance that it has entered into an
agreement with agencies administering other insurance affordability programs to fulfill the
requirements of 457.348(a) and will provide this agreement to the Secretary upon request.
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.

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