Revision 15-4; Effective October 1, 2015

 

 

D—1310 General Policy

Revision 15-4; Effective October 1, 2015

 

CHIP, CHIP Perinatal

Case disposition is the result of the eligibility determination once all required information is obtained and an individual’s notice of eligibility status is generated.

The notice explains if the case/application is pended, certified, sustained or denied.
The household must submit all missing information by the 45th calendar day from the file date. If the family fails to submit the required information timely, the application is denied.

When an eligibility determination is made, the household is notified of the child's eligibility status in writing. In addition, households must be informed in the denial and disenrollment letter of:

  • their rights and responsibilities;
  • right to request a review of the case decision; and
  • commercial insurance options through a referral to the Texas Department of Insurance toll-free telephone number at 1-800-252-3439 and the website at www.texashealthoptions.com.

The system automatically sends individuals determined ineligible for Medicaid and the Children's Health Insurance Program (CHIP) at application, redetermination or when processing a change to the Marketplace for an eligibility determination for federal health care coverage programs.

To qualify for the federal health care coverage programs, all individuals must first be determined ineligible for Medicaid and CHIP. Advisors must test whether an individual is eligible for all Medical Programs. The Texas Works Medical Programs Hierarchy, explained in A-132.1, Medical Programs Hierarchy, does this automatically for most clients.

Note: Advisors must follow a manual process when retesting eligibility for a minor parent aging out of CHIP, as explained in A-2342.1, Retesting Eligibility.

 

D—1320 Notice of Decision

Revision 13-4; Effective October 1, 2013

 

CHIP, CHIP Perinatal

Form TF0001, Notice of Case Action, advises the household of the:

  • potential household eligibility and who is potentially eligible;
  • need for the household to return a health plan selection and enrollment fee, if required;
  • reason the application was denied, terminated or reinstated;
  • effective date of the denial, termination or reinstatement; and
  • right to request a review.

 

D—1330 Correspondence Processing

Revision 15-4; Effective October 1, 2015

 

CHIP, CHIP Perinatal

CHIP correspondence refers to written documents or a request for review from a household or applicant for enrollment into CHIP. Correspondence may be submitted online at YourTexasBenefits.com, by fax, or through the mail. Uploaded, faxed, or hard copy correspondence documents are linked with the appropriate case. Types of correspondence may include:

  • provider claims;
  • plan transfer form or letter;
  • letter requesting address or name change;
  • missing information requested by CHIP through application processing;
  • requests for disenrollment;
  • enrollment requests;
  • request for review of an eligibility or enrollment decision; and
  • cost share updates.