This will be used when an individual who is covered under the State Employee Health Plan applies for benefits during Open enrollment (typically October), and they would be otherwise CHIP eligible if they did not currently have Comprehensive Health Insurance. In this process the original application will be completed and denied. A case flag will then be set. The case flag will then be used to track these individuals. Once January is available in KEES, a new Case Application will need to be created, individuals reapplied for, and the application processed following the steps below to approve benefits starting in January. If the individuals are NOT otherwise CHIP eligible, or they are being denied for something other than having Comprehensive Health Insurance, this process does NOT apply.
CHIP eligibility is identified for State Employee child who has existing OHI currently
Deny Case for Application Month. KEES Denial notice will need to be deleted.
Using the V008 send the Denial and Pre-Approval verbiage. This will be in the Standard Copy and Paste templates provided by KDHE Policy.
Set Case Flag: “State Employee- Future CHIP Eligibility”
Case flag will have a start date of the first of the Application Month.
End first step of the process
Next steps are to be followed once January is available in KEES:
Reapply and Create a Case Application for the previously denied CHIP Eligible Applicants that were Denied in step 2:
App date will be the first of current month
Ensure all data collection is completed as necessary for eligibility.
Run EDBC for Application Month. If nothing has changed, then the child should once again be Denied. A Denial NOA will not generate.
NOTE: The below process will use 1 of 2 possible Rescind Reasons: 1st Month Ineligible or 2nd Month Ineligible. These will rescind the applicant to the first of the month after the app month (1st month ineligible) or the 1st of the 2nd month after the app month (2nd month ineligible).
To undo the denial that occurred from steps 6-8 use the Rescind button on the ‘Medical’ Detail page.
Change the Display Date to the month of application and click the View button to refresh the page with the new display date.
If the program block was closed, Click the ‘caret’ of the collapsed ‘Medical’ program block to expand the block and see the program details.
NOTE: Some instances may have a blended program block so it will not be collapsed.
In the ‘Medical’ program block, click the View Details button. The ‘Medical’ Detail page displays.
Click the Edit button to make the ‘Medical’ Detail page editable.
Click the Rescind button. The Rescind Detail page displays.
Select the radio button for the group of persons and the Effective Date to Rescind. The selection defaults to the most recent application event.
Select the applicable rescind reason from the Rescind Reason drop-down menu.
If processing an application for November, the 2nd Month Ineligible rescind reason would be used. This will leave November and December Denied and will rescind the month of January.
If processing an application for December, the 1st Month Ineligible rescind reason would be used. This will leave December Denied and will rescind the month of January.
Click the Save and Return button. The Rescind Confirmation page displays.
If the information is correct click the Save and Return button. The ‘Medical’ Detail page displays.
Click the Save and Return button. The Case Summary page displays.
Continue processing the benefits for the January.
Applicants should now be approved for CHIP.
Review the CE and Review Dates for accuracy.
CE Periods should be 1/20XX -12/20XX, as it should span a full year from the time of approval.
At this time, end date the Case Flag using the last day of the current month.