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D—121 Children's Health Insurance Program (CHIP)
Revision 15-4; Effective October 1, 2015
CHIP
A child must:
- be ineligible for Children's Medicaid;
- not be on Medicare;
- reside in Texas;
- be under age 19;
- be a U.S. citizen or non-citizen with valid proof of immigration/alien status;
- have total household net income at or below the applicable income limit; and
- be uninsured for at least 90 days or claim one of the good cause exemptions to the waiting period explained in D-1723.6, Good Cause Exemptions for Children Subject to the 90-day Waiting Period.
D—122 CHIP Perinatal
Revision 15-4; Effective October 1, 2015
CHIP Perinatal
To be eligible for CHIP perinatal, a woman must:
- be pregnant;
- reside in Texas;
- have total household net income at or below the applicable income limit, depending on family size; and
- be ineligible for ongoing Medicaid and CHIP because of income or immigration status.
A pregnant woman is considered to be an adult the month of her 18th birthday.
A pregnant woman must be determined ineligible for Medicaid and CHIP before being tested for perinatal eligibility. CHIP perinatal coverage begins the first day of the month in which the eligibility determination is made.
The woman's age is calculated as of the month in which the proposed effective date of coverage will occur.
D—122.1 Post-Birth Eligibility Determination
Revision 15-4; Effective October 1, 2015
CHIP Perinatal
A woman is not eligible for perinatal coverage if she applies after the child is born. The advisor must deny the application upon becoming aware that the pregnant woman has delivered or had a miscarriage before the eligibility determination is made. The advisor must then determine whether the newborn is eligible for Medicaid or CHIP.
If the pregnant woman delivers or has a miscarriage before the eligibility determination and the advisor becomes aware of the delivery or miscarriage after the eligibility determination has been made, the woman's coverage is terminated. The woman will receive one month of CHIP perinatal coverage.
D—122.2 Notification of Birth
Revision 13-4; Effective October 1, 2013
CHIP Perinatal
Staff are notified of the perinatal child's birth via the:
- case authority who reports the child's birth by telephone or in writing;
- the newborn file; or
- birth notification from the health plan.