Household Composition Rules

The eligibility determination process for CHIP identifies the possible assistance units which exist in the current household. Unlike Low Income Families with Children (LIFC), all CHIP eligible household members are seen as 'optional', as they do not have to receive CHIP coverage if they do not want it.

For example, an applicant (aged 18), the applicant's husband (aged 18), and the applicant's child (aged 1) are living with the applicant's mother (aged 42) and father (aged 44). The applicant's cousin (aged 16) and the cousin's son (aged 1) also live in the household. Assuming all the CHIP eligibility criteria is met, there are a number of different assistance units, based on different combinations, that could apply:

1. Applicant, Applicant's Husband and Applicant's Daughter.
2. Applicant
3. Applicant's Husband
4. Applicant's Daughter
5. Applicant and Applicant's Husband
6. Applicant and Applicant's Daughter
7. Applicant's Husband and Applicant's Daughter
8. Applicant's Cousin and Applicant's Cousin's Son
9. Applicant's Cousin
10. Applicant's Cousin's Son

For CHIP, rather than displaying every possible combination and having validations to ensure a household member cannot receive CHIP in more than one assistance unit, each different result is displayed with one assistance unit containing every member who could potentially receive coverage under the same product delivery. The caseworker chooses which members to proceed with during case creation; these members then become part of the benefit group. Using the example above, there are 2 results displayed on the eligibility result page:

1. Applicant, Applicant's Husband and Applicant's Daughter
2. Applicant's Cousin and Applicant's Cousin's Son

If the applicant is the only child who wants coverage, the caseworker selects result 1 from the eligibility result page, and at a later stage during the process, the caseworker selects the applicant as the one to proceed with. A product delivery is created for the applicant where she is the only member of the benefit group.

If the applicant's cousin also wants coverage, both result 1 and 2 are selected, and the caseworker chooses who to proceed with for both results. Both the applicant and the cousin will have their own product delivery, as they cannot exist together in the same benefit group based on the household composition rules.

The household composition rules used to determine what individuals can exist together in an assistance unit are as follows:

• Child who satisfies the CHIP eligibility rules*
• Child's siblings, half, adopted and step who also satisfy the CHIP eligibility rules
• Parents and stepparents of any child, if the parents and stepparents satisfy the CHIP eligibility rules
• Children of any child if the children satisfy the CHIP eligibility rules
• The spouse of any child if the spouse satisfies the CHIP eligibility rules

*The CHIP eligibility rules refer to the CHIP Specific Eligibility Requirements and the standard Non-Financial Requirements rules (Citizenship, SSN and Residency).