601-3 Cost Sharing Exemptions for American Indian/Alaska Native Children

Effective: February 1, 2018

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In certain instances, families may be exempt from paying any co-payments, and in some cases any quarterly premiums. The health plan identification card shows providers when clients are exempt from paying any co-payments and deductibles.

1      American Indian/ Alaska Native Children are not required to pay co-payments or quarterly premiums.  (The application forms have an optional field for CHIP applicants to declare their race.)

A           Applicants:  Allow CHIP coverage with the cost sharing exemption when an individual declares to be an American Indian/Alaska Native, and there is no evidence that contradicts their claim.

a           Give the client reasonable time to provide documentation of their status.  "Reasonable time" is at least 30 days.  A client may request more time if needed.

b           If the client has been given reasonable time and does not provide the documentation or proof that they are working on obtaining it, remove the exemption with proper 10 day notice.

B           Enrollees:  Request proof of American Indian/Alaska Native status of CHIP enrollees at their first review after July 1, 2010 if their status was self-declared at application and tribal verification has not yet been provided.  

a           If the client fails to provide the verification at renewal or if the verification shows that they are not an American Indian or Alaska Native, stop the exemption with proper 10 day notice.

C          If verification of their American Indian/Alaska Native status is received at any time, continue or start the cost sharing exemption.

a      Any past cost sharing monies paid during the 12 months prior to the month of verification will be refunded to the client.

b      No cost sharing should be collected once verification is received.

D          Acceptable verification of American Indian/Alaska Native Status can be met with ONE of the following.

a           Tribal Identification/Enrollment Card or Number.

b           Certificate of Degree of Indian or Alaska Native Blood (CDIB) signed by the Bureau of Indian Affairs (BIA).

c            Tribal court documents.

d           Indian Health Services (IHS) Face Sheet.  An Indian Health Services (IHS) face sheet is a medical record certified by IHS as being from their original records.

ยท        The face sheet must contain identifying information about the client. IE, name, date of birth.

Click the following link for a list of federally recognized tribes:

https://www.federalregister.gov/documents/2017/01/17/2017-00912/indian-entities-recognized-and-eligible-to-receive-services-from-the united-states-bureau-of-indian