Revision 17-2; Effective April 1, 2017

CHIP

A child may be eligible from birth through the month of the child’s 19th birthday. Age is self-declared.

The certified group contains only the Children’s Health Insurance Program (CHIP) eligible child. Only one child is certified per Eligibility Determination Group (EDG).

CHIP Perinatal

A pregnant woman of any age may qualify for perinatal coverage.

When the pregnant woman is age 18 and it is anticipated that she will turn age 19 before her CHIP enrollment start date, the CHIP coverage is denied. She is tested for Pregnant Women Medicaid (TP 40) and then for CHIP perinatal, if ineligible for Pregnant Women Medicaid (TP 40). If eligible for CHIP perinatal, her enrollment start date is the first day of the eligibility determination month.

Only one pregnant woman is certified per EDG.

If the mother’s income is:

• Above the applicable income limit for Pregnant Women Medicaid (TP 40), as defined in C-131.1, Federal Poverty Income Limits (FPIL), the mother will be the only individual on the EDG for the majority of the certification period. During the month the child is born, the mother and the child are certified on the same EDG. After the month the child is born, the child is the only individual certified on the EDG.
• At or below the applicable income limit for Pregnant Women Medicaid (TP 40), as defined in C-131.1, and the mother receives Emergency Medicaid (TP 36) to cover the birth, the child will be certified on their own Medicaid for Newborn Children (TP 45) EDG.

CHIP, CHIP Perinatal

The following individuals are not eligible to receive CHIP or CHIP perinatal:

• Medicare recipients;
• inmates of a public institution; and
• residents of state supported living centers or institutions.

Exception: A child who is institutionalized (except for inmates of a public institution) during the child's continuous enrollment period remains eligible until the CHIP redetermination.

Revision 15-4; Effective October 1, 2015

CHIP, CHIP Perinatal

Modified Adjusted Gross Income (MAGI) household composition is used to determine whose needs, income, and expenses are considered in determining an individual’s eligibility for CHIP and CHIP perinatal. Each MAGI household composition is determined on the individual level. Individuals living at the same physical address may have a different MAGI household composition. MAGI household composition is based on federal income tax rules.

An individual does not have to file a federal income tax return to apply for CHIP or CHIP perinatal.

 

D—321 Who Is Included

Revision 16-4; Effective October 1, 2016

CHIP, CHIP Perinatal

Advisors must follow the policy described in A-240, Medical Programs, to determine who should be included in each individual’s MAGI household composition.

CHIP

When determining eligibility for a pregnant child, the expected number of the pregnant child's unborn children are included in the pregnant child's MAGI household composition.

CHIP Perinatal

When determining eligibility for a pregnant woman, the expected number of unborn children are included in the pregnant woman's MAGI household composition.

If the CHIP perinatal MAGI household composition includes other pregnant women, the expected number of unborn children of the other pregnant women are also included in the CHIP perinatal MAGI household composition, regardless of whether the other pregnant women are certified on a medical program.

Related Policy

Inclusion of the Unborn, A-241.1.5

 

D—322 Who Is Not Included

Revision 16-4; Effective October 1, 2016

CHIP, CHIP Perinatal

Advisors must follow the policy described in A-240, Medical Programs, to determine who should be included in each individual’s MAGI household composition.

CHIP

The expected number of  unborn children are not included in a non-pregnant child's MAGI household composition for CHIP when a pregnant child is included in the household.

 

D—323 Minor Parent Situations

Revision 15-4; Effective October 1, 2015

CHIP, CHIP Perinatal

Advisors must follow the policy described in A-240, Medical Programs, to determine who should be included in each individual’s MAGI household composition.

Revision 15-4; Effective October 1, 2015

CHIP, CHIP Perinatal

Either parent may apply on behalf of the child(ren) if they meet the criteria explained in A-121, Receipt of Application for Medical Programs. A custodial parent is established based on the policy explained in A-240, Medical Programs, Living Arrangements.

Revision 15-4; Effective October 1, 2015

CHIP, CHIP Perinatal

Children in state hospitals may be eligible as independent children for a 12-month period. In order to be admitted to a state hospital, the child must:

• be under age 19;
• be a U.S. citizen or Lawful Permanent Resident who entered the U.S. prior to Aug. 22, 1996;
• be a ward of HHSC via court civil commitment; or
• have or obtain a Social Security number (SSN).

A representative from the state hospital completes the application and attaches a cover sheet to specify the application is from the state hospital. In addition, the representative attaches copies of unpaid medical bills and, if applicable, Form H1113, Application for Prior Medicaid Coverage.

The application lists the:

• independent child's name as the head of household;
• SSN;
• date of birth;
• parents or UNKNOWN in other parent section;
• income and resources (if any);

Note: Resources are not considered as a factor in determining eligibility for CHIP or CHIP perinatal.

• insurance information;
• dates of service may be in the month of the child's 19th birthday or sooner;
• representative from the state hospital in the authorized representative section;
• signature of the representative from the state hospital who completed the application; and
• address of the state hospital in the residence and mailing address section, except for Terrell State Hospital (Terrell State Hospital lists the independent child's original residence address and the facility address in the mailing address).

If the independent child has no income, no other information is required to complete the application processing.

CHIP

An institutionalized child is not eligible to apply for CHIP. Exception: When a child is currently enrolled in CHIP and enters a state mental health facility, the child remains enrolled in CHIP until the end of the child's current enrollment segment.