Revision 15-4; Effective October 1, 2015
CHIP, CHIP Perinatal
Once determined eligible for the Children’s Health Insurance Program (CHIP) or CHIP perinatal, households must complete the enrollment process in order to receive benefits. The enrollment process includes choosing a health and dental plan and paying an enrollment fee, if applicable.
CHIP eligibility is prospective. TIERS provides the potential eligibility begin date and the Enrollment Broker provides the actual eligibility begin date.
The earliest a child can be eligible for CHIP is based on cutoff rules. When the Eligibility Determination Group (EDG) is disposed on or before the cutoff date, the potential eligibility begin date is the first of the month following the disposition month. When the EDG is disposed after cutoff, the potential eligibility begin date is the first of the second month following the disposition month.
Example 1 – Disposed on or before cutoff:
Disposed May 1, 2015; eligible June 1, 2015
Example 2 – Disposed after cutoff:
Disposed May 23, 2015; eligible July 1, 2015
D—1711 Expedited CHIP Enrollment
Revision 17-2; Effective April 1, 2017
Individuals who transfer during their non-continuous eligibility period to CHIP before their Medicaid certification period ends and who owe a CHIP enrollment fee may be eligible for expedited CHIP enrollment, with no gap in coverage if they are certified for one of the following Medicaid types of assistance:
- MA-Pregnant Women (TP 40);
- MA-Children Under 1 (TP 43);
- MA-Children 6-18 (TP 44); and
- MA-Children 1-5 (TP 48).
Individuals who meet the criteria may be enrolled in CHIP beginning the first of the month following their last month on Medicaid even when an enrollment fee is due but not yet paid.
The following case actions are eligible for expedited CHIP enrollment:
- Periodic Income Check (PIC) (except TP 40);
- appeal and reactivation due to change or PIC; and
- renewal processed by an advisor resulting in a shortened Medicaid certification period (except TP 40).
The following case actions are not eligible for expedited CHIP enrollment:
- appeal and reactivation due to reason other than change or PIC;
- retesting eligibility; and
- third party resources.
If determined eligible for CHIP, the Enrollment Broker will send an enrollment packet to households with eligible members. The enrollment packet will indicate the enrollment fee and options for selecting a health and dental plan.
Expedited CHIP enrollment is only applicable when transferring from Medicaid to CHIP when an enrollment fee is owed to ensure health coverage is maintained with no gap in coverage. Once the enrollment fee is paid in full, the household follows normal CHIP policy and procedure. If the enrollment fee is not paid by the deadline, the household is disenrolled.
Households who do not owe an enrollment fee do not qualify for Expedited CHIP Enrollment and are enrolled in CHIP and defaulted into a plan following current policies and procedures and cutoff rules if a health and/or dental plan is not selected.
Medicaid Termination, A-825
Enrollment Fees at Application, D-1821
Expedited CHIP Enrollment Process, D-1720.1
Involuntary Disenrollment, D-1761
Denial at Redetermination, A-2342
Eligibility Transition from Medicaid to CHIP, B-123.4
Actions on Changes, B-631
Periodic Income Checks, B-637