0920.020.30  MC+ Healthcare Coverage For CHIP Children

If all eligibility requirements are met, children are eligible for MC+ healthcare coverage.

No-Cost Group (LOC 1 or CHIP0)

Coverage for children in the No-Cost group begins with the first day of the month of application, provided the child is subsequently found eligible, and was not obviously ineligible for the entire month of application and any subsequent month prior to approval. If a child is obviously ineligible for the entire month of application and any subsequent months prior to approval, MC+ healthcare coverage begins with the first day of the month in which eligibility is met.

NOTE: Children in the No-Cost group are eligible for prior quarter determination, effective September 1, 2007. Refer to Section 0920.015.05.

Reduced Premium Group (LOC 2, CHIP73 and CHIP74)

Coverage for children in the Reduced Premium group begins with the date of application or the date the premium is paid, whichever is later. If a child is obviously ineligible for the entire month of application, MC+ healthcare coverage begins with the first day of the month in which eligibility is met or the date the premium is received, whichever is later.

Children in the Reduced Premium group are not eligible for prior quarter benefits.

Full Premium Group (LOC 3, CHIP75)

For children in the Full Premium group (except those with special healthcare needs, refer to Section 0920.020.05.20) coverage begins 30 days from the date of application or the date the premium is paid, whichever is later. For premium group children determined to have special healthcare needs coverage will begin on the date of application or the date the premium is paid, whichever is later. The exception to the 30 day waiting period only applies to the child(ren) with special healthcare needs, other children in the assistance group are still subject to the 30 day waiting period.

Example:

• Mrs. Wilson applies for MC+ for her one child, Jan, on September 1. She meets all eligibility requirements for the Full Premium Group (Level of Care 3, CHIP75) coverage. Mrs. Wilson also provides verification that Jan has special healthcare needs. Worker approves the case September 10. As Jan has special healthcare needs, there is no 30 day waiting period for eligibility from date of application.

  An invoice is mailed to Mrs. Wilson on September 11, the day after the approval. Mrs. Wilson's payment is received by the Premium Payment Unit on September 15. Jan's coverage begins September 15.

Children in the Full Premium group are not eligible for prior quarter benefits.

Note: It is important to remember that MC+ Premium Group healthcare coverage does not begin until the Premium Payment is received.

0920.020.30.05  Restrictions on Healthcare Services (CHIP)

Coverage for CHIP Premium group children (LOC 2 and 3, CHIP 73,74 and 75) is the same as that received by Non-CHIP MC+ children, except non-emergency medical transportation is not provided.

Coverage for CHIP No-Cost children is the same as that received by non-CHIP MC+ children.

Prior to September 1, 2005, there were cost sharing requirements for persons with gross income above 185%. Children in the Co-Pay Group (186-225% FPL) had a $5 co-pay at the time of each provider visit. Children in the Premium Group (226-300% FPL) had a $10 co-pay at the time of each provider visit and a $9 co-pay per prescription, in addition to the monthly family premium.

0920.020.30.10  MC+ HEALTHCARE COVERAGE END DATE ON CLOSINGS (CHIP)

MC+ healthcare coverage is date specific for all MC+ CHIP children at the time of closing.  The process is the same as for MAF (Refer to Section 0905.015.10)