The Childrens Insurance Application Community Organizations

1
The Childrens Insurance Application(Community
Organizations)

• Instructions for Completing

2
Agenda
1. Introduction
2. CHIP Process Overview
3. Getting Started
3. Application Review
4. Wrap-Up
3
Introduction

• Medical coverage for Childrens Medicaid and CHIP
  begins once the applicant successfully completes
  each of the following phases
• Application
• Eligibility
• Enrollment
• This training focuses on completing the
  application the first phase in the Childrens
  Health Insurance process.
• Note For more information about CHIP
  eligibility and enrollment, please review the
  Processing CHIP Applications and Renewals in the
  New Eligibility System training _at_
  www.chipmedicaid.org/cbo/app_process.htm.

4
Childrens Insurance Process Overview

• (CHIP/Applicant)
• Six months continuous eligibility
• If CHIP, select health plan and pay enrollment
  fee, if applicable

5
Tips for Getting Started

• Use blue or black ink only. The imaging software
  will not pick up any other color or pencil.
• Complete each section. Do not leave any items
  blank - check either Yes or No as
  appropriate.
• If Yes is the correct response, enter the
  additional information requested.
• For example Section 3, question a If the
  answer is Yes, provide complete information
  about the insurance company, including the name
  of the employer, policy holder, policy number,
  etc.
• Note Providing a partial or incomplete
  response will delay the process and generate a
  missing information notice.

6
Tips for Getting Started

• If the answer calls for a dollar amount to be
  entered and the balance is zero, enter 0.
• If the question does not apply to the family,
  enter None or N/A.
• Sign and date the application.
• If the applicant has proof of income, resources
  and citizenship or immigration status with them,
  make copies of the originals and attach the
  copies to the application. Do not send
  originals.
• TIP Some information collected on the
  application may only apply to Childrens
  Medicaid. Although this information is not
  applicable to CHIP, it is required to ensure the
  family is not eligible for Medicaid before
  processing the application for CHIP.

7
Tips for Getting Started

• Applicant screened eligible for Medicaid are sent
  to HHSC for an eligibility determination. If
  eligible, the child receives Medicaid for six
  months.
• Medicaid Renewals are handled by the local HHSC
  eligibility office, not CHIP. Do not send
  Medicaid Renewals to CHIP.
• On a CHIP application for renewal, it is
  important to correct any pre-populated
  information that is incorrect.

8
Tips for Getting Started

• On each piece of information attached to the
  application, write the applicants first and last
  name, Social Security number or other identifying
  information (e.g., childs name, family name and
  address, etc).
• The applicant may request a receipt (Form H1800,
  Receipt for Application/Medicaid
  Report/Verification/Report of Change) when
  submitting an application and/or verification by
  mail, phone or fax.

9
Sections 1 and 2
Section 1 Applicant Information
Section 2 Children Information
10
Section 1 Applicants Information

• Person applying for services must enter his/her
  information in this section.
• Enter a reliable phone number or contact number
  in case CHIP or HHSC needs to contact the
  applicant.
• Select the appropriate language preference.
• TIP The person identified in this section will
  be the case name and receive all correspondence.

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Section 2 Childrens Information
a-b Indicate the first and last name for each
child living in the home. c Indicate if
applying or not applying for each child. d
Indicate the childs relationship to the person
in Section 1. If an independent child, indicate
self.
e-f Enter the date of birth and gender for each
child in the home.
TIP If the applicant has more than four
children, use a separate sheet of paper and
provide all requested information.
12
Section 2 Childrens Information
g If the applicant answers Yes and the child
is determined eligible for Medicaid, the
applicant will be required to verify the childs
U.S. citizenship. Note This is not a
requirement for CHIP eligibility. If the
applicant answers NO and the Child is a legal
permanent resident, verification of the childs
immigration status is required at
application. TIP If copying this information
for the applicant, make sure the documents are
legible.
13
Section 2 Childrens Information

• h Enter the Social Security number for each
  child. This is required.
• i-m Indicate the first, maiden and last name of
  the mother, and the first and last name of the
  father for each child in the home.
• n Indicate the appropriate response for school
  attendance.
• o Enter each childs race, i.e,
  African-American, Hispanic, White, etc
• TIP It is very important to identify the
  school attendance status for each child. The
  earnings of a child attending school do not count
  towards the familys total income.

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Sections 3, 4 and 5
Section 3 Insurance Information
Section 4 Optional Questions
Section 5 Parents in the Home
15
Section 3 Insurance Information

• a Indicate if the child has or had private
  health insurance, CHIP or Medicaid in the last 90
  days. Make sure to enter all information from
  Insurance Company Name through Phone.
• If the insurance coverage will end within the
  next 60 days or has ended, enter the date the
  health coverage will terminate or terminated and
  mark the appropriate reason box.
• Tip Make sure the applicant marks the
  appropriate reason the insurance terminated.

16
Section 3 Insurance Information

• b-c If insurance is available through the
  applicants employer and the child qualifies for
  Medicaid, all or part of the insurance premium
  may be reimbursed by the Health Insurance Premium
  Payment Program.
• Tip Make sure the applicant enters the cost of
  the insurance on line c.

17
Section 4 Optional Questions
Question 1 Although optional, this information
is used to determine if the household is exempt
from CHIP cost-sharing responsibilities and
Medicaid Managed Care. Questions 2-4 If
Medicaid eligible, these populations are exempt
from mandatory enrollment in Medicaid Managed
Care.
18
Section 5 Parents in Home

• Enter the first and last name of the parents and
  step-parents living with the children even if
  this information was provided in Section 2.
• In Relationship to Child, make sure to mark the
  appropriate selection.
• If the applicant is not the parent or
  step-parent, write N/A.

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Sections 6 through 9
Section 6 Income
Section 7 Pregnant Members
Section 8 Expenses
Section 9 Assets
20
Section 6 Income

• Enter the name of any person in the home who
  receives money. Enter the employers name or the
  source of the income.
• Enter how often the income is received (weekly,
  bi-weekly,etc) and how much the person receives
  per pay period DO NOT enter the total received
  per month unless the person is paid monthly.
• If no one in the household receives income from
  other sources or employment, enter N/A in Name
  of person receiving money and 0 in How
  much?.
• Tip For earnings, attach copies of paycheck
  stub(s) issued within the last 60 days or the
  familys most recent IRS tax return. Make sure
  to include the Schedule C if the income is from
  self-employment.

21
Section 7 Pregnant Women

• a Indicate if a member of the household is
  pregnant and the expected delivery date.
• b Enter the name and address of the father of
  the unborn child. This information is necessary
  to process applications for Medicaid for Pregnant
  Women.

22
Section 8 Expenses

• Provide detailed information if the family has
  child care or adult day care expenses or if child
  support or alimony payments are made to anyone
  outside the home. Make sure to complete this
  section fully from Type of Expense to Name,
  Address and Phone number of the Person You Pay.
  
• Write N/A in the Type of Expensecolumn, if
  the family does not have any expenses.

TIP The applicant must provide proof of all
expenses to reduce the countable gross income for
Medicaid. Verification of the expense could help
the family qualify for Medicaid, which provides
no-cost health care coverage for children.
23
Section 9 Assets

• 9a The amount should reflect the total of all
  accounts for household members included in the
  budget group or family size.
• Enter the combined total for
• Checking account(s), after paying monthly
  expenses
• Savings account(s)
• Trust funds
• Certificates of Deposit (CDs)
• Stocks
• Bonds
• Cash on hand

24
Section 9 Assets

• List vehicles owned by the parent or step-parent.
• b If the family does not own a vehicle, indicate
  N/A in all three columns in item 9b.
• TIP CHIP uses a third party data broker to
  verify vehicle values and ownership. If the data
  broker reveals vehicles owned by members of the
  family not included in 9b, CHIP sends the family
  a missing information letter.

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Sections 10 through 14
Section 10 Other Information
Section 11 Voluntary Authorized Representative
Section 12 Rights Responsibilities
Section 13 Required Documents
Section 14 Signature
26
Section 10 Other Information

• Mark Yes if the family has unpaid medical bills
  incurred in the last three months.
• Medicaid can provide coverage in prior months if
  a child
• Has unpaid medical bills in the last 3 months
  prior to the application, and
• Qualifies for Medicaid.
• TIP If the child has unpaid medical bills
  incurred in the three months prior to
  application, make sure the applicant attaches
  copies of the bills.

27
Section 11 Authorized Representative

• The Authorized Representative is someone the
  applicant designates to
• Check the application/case status
• Receive information about the case
• Report changes, or
• File a complaint
• TIP The Authorized Representative cannot be an
  agency however, this person could be someone
  working for a Community Based Organization (CBO).
  

28
Section 12 Rights Responsibilities

• Make sure the family understands what they are
  signing.
• Either advise the applicant to read this section
  or read it to them before the application is
  signed.

29
Section 13 Required Documents

• Use the Required Documents checklist to make
  sure the applicant attaches the required
  information before submitting the application.
• If the applicant does not have the information
  available, make sure he/she understands that CHIP
  will
• Send a missing information letter, and
• Request these documents before eligibility for
  Medicaid or CHIP can be determined.

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Section 14Signature

• Make sure the applicant signs and dates the
  application. The application is not valid without
  a signature.

31
Wrap-Up

• Use the following questions to make sure the
  application is complete and ready to send to
  CHIP
• Are all data fields complete?
• Did the applicant sign the application?
• Is verification/proof attached?
• Copy of the Legal Permanent Residence Card (front
  and back)
• Copy of childs birth certificate
• Letter verifying private health insurance
  termination
• Paycheck stubs issued within the last 60 days or
  the most recent IRS tax return with Schedule C,
  if applicable
• Receipts for dependent care, child support or
  alimony payments
• Does the family have an envelope to mail the
  application?

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Contact Information
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• Thanks for participating!