M1803 Kid Care CHIP

Purpose: This section will assist in determining Kid Care CHIP eligibility for children ages 0-18 years.

Current Policy Effective Date: February 14, 2022

Date Last Reviewed: May 13, 2022

Previous Policy: October 1, 2020

POL M1803: DETERMINING ELIGIBILITY FOR KID CARE CHIP

1. Applicants Must Meet Basic Eligibility Factors

Refer to Section M600 for a description of all basic eligibility factors.

2. Applicants Must Be Under Age Nineteen

3. Applicants Must Meet Income Requirements

Countable family income must be over the Medicaid income limit of 154% of FPL for children 0-5 and 133% of FPL for children 6-18, but less than or equal to 200% of FPL for all children 18 and under. Refer to Medicaid Table 1. Refer to Table 2A to determine if income is countable.

4. Applicants Do Not Have Resource Test

5. Applicants Must Not Have Other Health Insurance Or Be Eligible To Enroll In The Wyoming State Employees Health Plan

6. Benefits Begin First Day Of The Application Month If Determined Eligible

7. Kid Care CHIP May Not Receive Retroactive Coverage

Do not authorize retroactive benefits unless they are found eligible under another coverage group allowing retroactive medical assistance.

8. Applicants May Have Eligibility For 12 Continuous Months

The eligibility continues for 12 months from the effective date of eligibility or for 12 months from the last periodic review.

9. Clients Must Be Reviewed

Clients must be periodically reviewed every 12 months to determine continued eligibility. Refer to Section M1403 for information on reviewing eligibility.

Clients must be reviewed for other Medicaid program eligibility before closing cases.

10. Clients Who Transfer To A New Coverage Group

Clients who turn one under the Newborn program, need to be transitioned to the Child MAGI or Kid Care CHIP coverage group, the first day of the next month, following the child’s birthday.

11. Clients May Lose Benefits

The case will close on the first day of the next month when any of the following occur:

• • Client does not complete review.

  • Client enters a public institution, excluding the Geriatric Hall at the State Hospital in Evanston.

  • Client dies.

  • Client moves out of state.

  • Client determined no longer eligible.

  • Client starts receiving other health insurance coverage.

Reference:

Defining Group: 42 CFR 435.229

Social Security Act § 1902(e)(12)

Income: Social Security Act § 1902(a)(10)(A)(i)(VI)

Social Security Act §1902(a)(10)(A)(ii)(IX)

Clarifying Information:

A child is defined as a dependent between birth and 18 years of age who is not an emancipated minor or a minor parent.

Asset Transfer Provisions Do Not Apply.

Worker Responsibilities:

Determining Countable Income

1. Refer to Table 2A for information on countable income.

Closing Cases

1. Send 15-Day closure notice when an adverse action has occurred.