Revision 24-2; Effective April 1, 2024

CHIP

Children are granted 12 months of continuous coverage.

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 following 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. Following 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 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 24-2; Effective April 1, 2024

CHIP

The following are exceptions to the period of continuous enrollment:

  • a child being added to the household who is determined eligible for coverage on a date after the beginning of coverage for at least one sibling has had eligibility established to align certification periods;
  • 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;
  • confirmation that the child no longer lives in the state;
  • the child or authorized representative (AR) requests voluntary disenrollment in writing; 
  • 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 enrollment fees at application or redetermination on behalf of a child.

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.