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State Children’s Health Insurance
Program (SCHIP)
What Makes Your Client Eligible
Although each state has different
eligibility rules, in most states your client's
child is eligible for SCHIP if he/she:
- Is uninsured, 18 years
old or younger, and has low income
- Meets the specific SCHIP eligibility criteria
established by your state
Your state will determine whether your client’s child
is eligible for Medicaid prior to enrollment in SCHIP. Federal law requires
that ineligibility for Medicaid be established prior to approval for
SCHIP coverage.
SCHIP eligibility rules vary from state to state. Please
check with your state SCHIP program office by calling 1-877-KIDS-NOW
or visiting www.insurekidsnow.gov to
learn about eligibility criteria in your state.
 Application
Process
Renewal
Process
Appeals
Process
Application
Process
The application timeframe for SCHIP enrollment varies from state to state and
depends on whether the state uses a joint Medicaid/SCHIP application or a separate
(non-Medicaid) SCHIP program application. In general, the application review
may take as little as five to 10 days, or as long as 45 days.
Many states have adopted policies that simplify the application,
eliminate asset tests and/or face-to-face interviews, and minimize supporting
documentation requirements. Most states with Medicaid and SCHIP programs
use a joint application to prevent families from having to complete a
second application if they are found ineligible for one of the programs.
Application Approvals: Approval
is based upon a review of the completed SCHIP application and verification
documents. A decision is then made that the applicant is eligible and
coverage can be initiated.
Application Denials: The
automated computer system (used in some states) or eligibility staff
can deny your client for a number of reasons, but there are two primary
types. The first is a denial if your client is ineligible because his/her
income exceeds limits for the program or because of reasons related to
other categorical eligibility requirements such as age. The second type
of denial is known as a procedural denial. The most common reasons given
for procedural denials are lack of required verification documents, failure
to keep interview appointments, or failure to return information.
For more information on the application process and timeline
for SCHIP in your state, visit www.insurekidsnow.gov/states.htm.
Renewal
Process
Toward the end of a coverage period, your client
will be notified in writing that action is needed
in order to continue coverage. Your client will
have to update information, either by submitting
income and other verification documents or by
self-declaring information required by your state
to renew eligibility. The time at which your client
must renew his/her child’s benefits is determined
by your state.
Your state may send a pre-printed form to your client that
includes eligibility information your client must verify. Some states
require that the form be signed and returned. In other states, if the
information sent to your client is correct, he/she will not need to return
the form or contact eligibility staff to continue receiving benefits.
The latter is often referred to as a passive renewal process.
Based on your state’s policy regarding the coverage
renewal process, a decision is made to continue coverage or to stop coverage.
The reasons for stopping coverage are very similar to the application
denial reasons discussed earlier, such as inadequate information.
Appeals
Process
The appeal process for SCHIP enrollment varies from state to state. Each state
must have established written procedures for client grievances and appeals.
SCHIP requires access to a fair, unbiased, and timely appeals process.
Please
check with your state SCHIP office for more information on the appeals process
in your state, or visit www.insurekidsnow.gov/states.htm.
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