805 Case Closure

Effective: July 1, 2017

Previous Policy

A           When an enrollee requests his case be closed or when no one in the household is eligible, close the case and send proper notice. (See 220-2 for information about children who enroll in private health insurance.)

B           When a client receives improper CHIP coverage and there are no other CHIP eligible individuals, close the CHIP in the month the agency can give proper notice (803 & 806).

C          If you cannot give 10-day advanced notice for any adverse actions, continue benefits to the following month. (See 803 for exceptions to 10-day advance notice requirements.)

D          If a CHIP case closes because all of the children become eligible for Medicaid and then Medicaid eligibility is lost, re-determine eligibility for CHIP.  A new application form is not required; however, all factors of eligibility must be verified and met.

E           When a CHIP client requests UPP and is determined eligible, continue CHIP through the end of their enrollment period unless the client provides proof of enrollment in their employer sponsored health insurance.

o      If the client provides verification, close the CHIP at the end of the month for which the eligibility agency can give proper 10-day notice.  

F           Client information will be transferred to the FFM if the client is no longer eligible for CHIP.