Revision 13-4; Effective October 1, 2013

CHIP, CHIP Perinatal

Advance Notice — A notice of adverse action that expires 13 days after it is sent, with the exception of a six-month income check. Households denied at a six-month income check are given a 30-day advance notice of adverse action.

Adverse Action — An action resulting in denial or termination of assistance.

Applicant — An individual who submits an application to apply for assistance.

Case Authority — An individual who has the authority to act on behalf of the child. Examples include parents who live with the child, grandparents who live with the child, spouse, independent child, payee or authorized representative.

Children's Insurance — Includes Children’s Medicaid and Children's Health Insurance Program (CHIP).

Community Based Organization (CBO) — Organization providing assistance to an applicant applying for and enrolling in state-funded programs by aiding in the application process and seeking answers to case inquiries.

Disenrollment — The process by which a child's CHIP coverage is removed.

Enrollment — The process by which a child's CHIP coverage begins.

Enrollment Broker – Entity that enrolls an eligible child into CHIP or an eligible pregnant woman into CHIP perinatal once health and dental plan selections have been made and any required enrollment fees have been paid.

Enrollment Missing Information — Required information needed to complete the enrollment process that includes choosing a health plan and paying an enrollment fee.

Net Income — Gross income less the allowable child care deduction.

Perinate — An individual from the period of conception to birth. The unborn child.

Plan Partners — Organizations contracted through HHSC to provide health, dental or vision care services to CHIP enrolled children.

Request for Review — A written expression of dissatisfaction of an adverse action taken on a CHIP case. CHIP recipients are not allowed fair hearings.