The Children's Health Insurance Program (CHIP) provides medical services to eligible children under the age of 19 who do not have health insurance and do not qualify for Medical Assistance. The Children's Health Insurance Program (CHIP) is part of Cúram Medical Assistance. Like other Medical Assistance coverage types, the information required to determine program eligibility is captured as evidence. This evidence is assessed against a set of business rules to determine whether or not an individual is eligible for CHIP. Eligibility for CHIP is determined as part of the existing cascading eligibility rules for Medical Assistance coverage types. The cascading eligibility process determines coverage type eligibility based on a hierarchy. The hierarchy is used to determine the order in which the coverage type rules are executed. The eligibility rule set for the coverage type with the highest priority are executed first, followed by the rules for the coverage type of next highest priority. The rules for the categorically needy coverage types (including cost sharing coverage types) are executed first followed by the rules for the medically needy coverage types. CHIP eligibility is only determined if an individual is ineligible for all the categorically needy/medically needy coverage types. This hierarchy is configurable within the product to meet the individual requirements of a state.
There are a number of additional features associated with the Children's Health Insurance Program (CHIP). Because of limitations on funding and available slots in the program, applications for CHIP are only accepted during open enrollment periods. Open enrollment is the period of time during which eligible individuals can apply for CHIP. States limit the numbers they enroll according to the funds available for the program. Once this period has passed, unless exempt, for example a newborn, it is not possible to apply for this program. A processing entity, Enrollment Details, is used to record time periods when applications can be accepted by the state.
Unlike Low Income Families with Children (LIFC), individuals eligible for CHIP can choose whether or not they wish to receive the program. There are no mandatory assistance unit members; therefore, families can decide what child(ren) in the eligibility result need coverage.
To receive CHIP coverage, families may be required to pay premiums. This depends on whether or not the state requires premiums for coverage. The application of premiums is controlled by an environment variable to facilitate customization by individual states.
If premiums are applicable, the billing, collection and allocation of premiums is managed by an external vendor.