When changes are made to the benefit group in the Children's Health Insurance Program (CHIP), reassessment of CHIP is triggered automatically. The premium and copayment records should be automatically updated with any new information.
The caseworker can only add household members who currently exist on the integrated case and who were determined eligible for CHIP on the most recent decision for the product delivery. This will be any child who decided not to be covered by CHIP even though eligible originally, any child who was previously ineligible but who is now eligible as a result of a change in circumstance or a child who is a recent addition to the household such as a newborn.
Once a new member is added to the product delivery, an automatic reassessment of the product delivery is triggered to ensure this person is still eligible. An additional child can be added to CHIP only if it is during an open enrollment period unless the child is a newborn or has just lost coverage to regular medical assistance. This is controlled by the CHIP eligibility rules which have to be run for the 'new' child. If the new child is eligible, the following happens:
A child can stop CHIP coverage at any stage if desired. When a household member is removed, the member will still receive coverage under CHIP up to and including the last day of the month. The caseworker is notified to take the appropriate action. If there was only one child on the case, the case is closed after the last day of coverage. If there are other children on the case, the case remains open and the affected child is removed from the benefit group on the last day of coverage.
A family may reach their co-payment limit by removing a child. It is up to the family, however, to track their co-payments and notify the department once this happens.