Revision 15-4; Effective October 1, 2015

 

 

D—1510 General Information

Revision 15-4; Effective October 1, 2015

 

CHIP

Children certified on the Children’s Health Insurance Program (CHIP) with income above 185 percent of the Federal Poverty Income Level (FPIL) will have a six-month income check to determine whether the child remains financially eligible.

An automated income check, explained in B-637, Periodic Income Checks, for CHIP, is run in the fifth month of the certification period when the following conditions have been met:

  • The client’s income at application was above 185 percent of FPIL;
  • The individual will not age out before or during the fifth month;
  • Any of the following is true for at least one individual in the Modified Adjusted Gross Income (MAGI) household for at least one countable income or expense source:
    • An income or expense is not verified;
    • One of the following income types uses “Verified by Reasonable Compatibility” as the verification source:
      • Employment income;
      • Unemployment compensation income; or
      • Retirement, Survivors, and Disability Insurance (RSDI) income; or
    • The verification source is anything other than “Verified by Reasonable Compatibility” and the verification received date is more than 60 days old;
  • The case is in Approved Ongoing Mode; and
  • There are no pending Task List Manager (TLM) tasks for the case.

The result of the income check may impact eligibility in the seventh month.

The household is provided at least 30 days advance notice prior to disenrollment. The household is entitled to a request for review and continued enrollment based on actions related to the six-month income check. Exception: The household is not eligible for continued enrollment if the denial is because the household failed to provide the information requested during the six-month income check.

If the household's income is at or below the applicable income limit for CHIP, the household remains on CHIP.

At the six-month income check, the Texas Integrated Eligibility Redesign System (TIERS) will send updated eligibility status or cost share details to the CHIP enrollment broker.

Note: CHIP perinatal households are not subject to the income check.

Related Policy
Periodic Income Checks, B-637
Exceptions to the Continuous Enrollment Period, D-1731
Request for Review, D-1920