701-2 Effective Dates of Certification

Effective Date:  June 1, 2016

Previous Policy

A.      New CHIP Applicants

A           CHIP enrollment begins the first day of the month in which the application is received.  If any family member is enrolled in an FFM plan see section 220-9 to determine the effective date for CHIP. 

Exceptions to benefits starting on the first day of a month:

o      The individual applies during the first four days of the month and the 4-Day Grace Period is allowed.  

o      The individual is enrolled in health insurance coverage that terminated involuntarily or COBRA coverage ends during the application month, in which case eligibility begins the day after the health insurance coverage ends.

o      The individual is sanctioned for voluntary termination of health insurance coverage and the ineligibility period ends during the application month, in which case eligibility begins the day after the ineligibility period ends.

o      The individual moved to Utah to take up residency during the application month, in which case eligibility cannot begin before the date the person arrived in Utah.

o      The individual is a qualified alien who was subject to the five-year bar for CHIP during the application month, in which case eligibility cannot begin before the date the five-year-bar ended.

o      The individual became a qualified alien who was not subject to the five-year bar during the application month, in which case eligibility cannot begin before the date the individual became a qualified alien.

o      The individual is released from a Utah jail or prison or discharged from the State Hospital or other IMD, in which case eligibility cannot be earlier than the date the person was released.

B           A pregnant woman who is in her third trimester of pregnancy may apply for CHIP for her unborn child even if she has no other children. The effective date is the date of birth. See section 230-1 for information on household composition.

C          When the applicant is a member of a family who was closed because they did not pay their quarterly premium, if they have been closed for less than three months, to be eligible, the family must pay any outstanding premiums.  It does not matter whether or not the applicant was included in the coverage when it was closed.  See Section 601-2 for further information.  

D          If the applicant is not eligible for the application month, the same application can be used to determine eligibility for the following month.  When denying the original application month and determining eligibility for the next month, the application date and the benefit effective date changes to the first day of that next month, subject to the following exceptions.

E           A Medicaid or UPP recipient reports a change that causes the client to no longer be eligible for Medicaid or UPP, but the client does qualify for CHIP.  The effective date of coverage for CHIP is the first day of the month immediately following the Medicaid or UPP closure.

 

B.       Four Day Grace Period

F           When an application is received during the first four days of a month and a child has a medical need, allow a grace enrollment period beginning no earlier than four days prior to the date an applicant submits a completed and signed application.  

G          To receive the coverage, the applicant must have been unable to apply during the last four days of the previous month because of an emergency situation.

H          The applicant must request that eligibility be determined for the grace period before the application process is completed. If they fail to request it until after their application is approved, they are not eligible for the grace period coverage.

I            All factors of eligibility must be met in the grace period.

J            Consider eligibility for the Child Medically Needy program when the grace period does not match the dates of medical need.

Examples

#1: An application is received on April 1 for CHIP.  The child had a medical need on March 28. The grace period and CHIP coverage can go back to March 28. 

#2 The application is received on July 3.  The child had a medical need on June 27.  The earliest date for the grace period is June 29.  Consider Child Medically Needy coverage for the month of June..