Revision 15-4; Effective October 1, 2015
CHIP
Children are granted 12 months of continuous coverage. Note: Households with income above 185 percent of the Federal Poverty Income Limit (FPIL) are subject to the six-month income check. See D-1510, General Information.
CHIP Perinatal
CHIP perinatal recipients are granted 12 months of continuous enrollment from the first day of the eligibility determination month. The 12-month period includes the months of CHIP perinatal coverage before and subsequent to birth. When the child is born, if the household's income was above the income limit for TP 40, defined in C-131.1, Federal Poverty Income Limits (FPIL), the child's coverage begins on the date of birth. The pregnant woman's coverage ends on the last day of the month that the child is born. The child's enrollment ends at the end of the original 12-month segment.
The child receives full CHIP benefits from the date of birth through the end of the continuous perinatal enrollment segment. Subsequent to delivery, the mother of the perinatal child qualifies for two postpartum care visits.
If a household reports a change in household size or income that would otherwise impact the household's eligibility, there is no disruption to the child's active enrollment segment.
D—1731 Exceptions to the Continuous Enrollment Period
Revision 23-2; Effective April 1, 2023
CHIP
The following are exceptions to the period of continuous enrollment:
- a child who is determined eligible for coverage on a date after the beginning of coverage for at least one sibling;
- a 19-year-old child;
- a pregnant child eligible for Medicaid;
- child currently covered on Children's Medicaid;
- confirmation that the child remains on health insurance and the household did not drop the third-party resource (TPR) at application or redetermination;
- the household reports a change that makes the child eligible for Medicaid;
- the household submitted a request for review because the household failed to provide information requested during the six-month income check;
- the household did not submit a redetermination packet;
- confirmation that the child no longer lives in the state;
- the child or authorized representative (AR) requests voluntary disenrollment in writing;
- a child becomes an inmate of a public institution.
- confirmation that eligibility was granted in error at the most recent determination or renewal of eligibility due to agency error or fraud, abuse, or perjury attributed to the child or AR;
- the child dies; or
- failure to pay required premiums or enrollment fees on behalf of a child.
Note: Households with income above 185 percent of the Federal Poverty Level (FPL) are subject to the six-month income check.
CHIP Perinatal
The following are exceptions to the period of continuous enrollment:
- current Medicaid coverage;
- confirmation of current health insurance coverage;
- confirmation that the woman or newborn no longer lives in the state;
- the AR requests disenrollment in writing;
- termination of pregnancy with no live birth;
- the birth is not reported by two months after the expected due date; or
- the mother was determined eligible after the birth month of the child.
Related Policy
Health Insurance, D-1210
Third Party Resources Changes, D-1437
General Information, D-1510
Health Insurance, D-1632.2
D—1732 Pregnant Members Aging Out of CHIP
Revision 15-4; Effective October 1, 2015
CHIP
A pregnant CHIP member who ages out of CHIP before her expected due date and who is determined eligible for CHIP perinatal is enrolled in perinatal beginning the first day of the month following her CHIP end date.