When evidence changes on the integrated case, reassessment is triggered automatically across all product deliveries and case groups are updated as necessary. This is out of the box functionality. If one of the product deliveries is a CHIP product delivery, the caseworker is notified to check eligibility across all Medical Assistance coverage types (in case they are now eligible for a more beneficial coverage type).
If the child is found ineligible for CHIP, it does not necessarily mean the child will lose coverage. Certain changes are essentially ignored until eligibility renewal. The types of changes and what happens is outlined in the sections below.
If any of the following changes occur, the child loses coverage:
The effective date of disenrollment is the last day of the month the change occurred unless the child has died, in which case the effective date is the date the child died. The caseworker is notified to take the appropriate action. If there was only one child on the case or if the change of circumstance affects all children on the case, the case is closed on the effective date of disenrollment. If only one child is affected by the change, the case remains open and the affected child is removed from the benefit group on the effective date of disenrollment.
*If the reason the child is eligible for regular medical assistance is solely because of a decrease in income, the child does not have to move if he or she does not wish to (until the end of the current eligibility period). However if the child is eligible for regular medical assistance because of any other change, the child must be removed from CHIP. This is a manual process which the caseworker must carry out.
When there is a change in income evidence, it must be evaluated to determine if it affects an individual's eligibility.
A reported income increase (adversely affecting the case or not) is not acted upon until the end of the current eligibility period when the family is applying for renewal. They remain covered under CHIP with the same premium amount and co-payment limit until the end of the continuous eligibility period.
A reported income decrease is not acted upon until the end of the current eligibility period when the family is applying for renewal. They remain covered under CHIP with the same premium amount and co-payment limit until the end of the continuous eligibility period (i.e. current certification).