703-1 Length of the Enrollment Period

Effective: April 1, 2011

Previous Policy

The enrollment period for CHIP is 12 months.  With few exceptions, once an applicant is determined to be eligible for CHIP, he or she remains eligible for the entire enrollment period.

1. A CHIP enrollee may lose eligibility before the end of the 12-month enrollment period in the following situations.

1. • An enrollee turns age 19 before the end of the enrollment period.

   • An enrollee moves out of state or cannot be located.

   • An enrollee enters a public institution.

   • An enrollee dies.

   • An enrollee requests a redetermination of eligibility and becomes eligible for another medical program, such as Medicaid without a spenddown, pregnant woman asset co-payment, or MWI premium. (See Section 703)

   • An enrollee begins to be covered by a 'creditable' insurance under a group health plan or other health insurance coverage including COBRA.

   • An enrollee becomes eligible to enroll in Medicare.

   • An enrollee becomes covered by the Veterans Administration Health Care System.

   • An enrollee failed to pay their quarterly premium and/or late fee.

See Section 220-9 #2 for information about what to do when an enrolled child gains access to coverage through an employer's health insurance coverage.

2. When to Allow a Due Process Month

• Review - if you cannot give 10-day notice before deciding eligibility, extend benefits to the following month. See Sections 704-1 and 803-1.

• Change Report - when you cannot give 10-day notice for an adverse action, continue benefits to the following month.

3. When to Establish a New 12-Month Enrollment Period

   • The enrollment period for CHIP must be redetermined at 12 months.  A new 12-month enrollment period will be established when:

   • 1. An enrollee completes the review process at the end of an enrollment period and continued eligibility for CHIP is established.

     2. The enrollee requested an income redetermination and they become eligible for a lesser cost CHIP plan (i.e. Plan C to Plan B or A; or Plan B to Plan A).

     3. A new 12-month enrollment period may be established during the certification period when a review is completed on another program and all information needed to determine CHIP eligibility is provided and CHIP eligibility does not change to a higher cost plan (Plan A to Plan B or Plan C; or Plan B to Plan C).

4. When Not to Establish a New 12-Month Enrollment Period

Do not establish a new 12-month enrollment period or recalculate income in the following situations:

4. 1. 1. The enrollee moved from  CHIP to UPP,

      2. The enrollee is requesting to go back to CHIP.

      3. The 12 month enrollment period has not ended, and there is no break in coverage between CHIP and/or Medicaid or UPP.

Complete the CHIP review at the end of the enrollment period.