Appendix 9
2003 Changes to Eligibility, Procedures and Contractor Requirements HHSC Rules
Proposed rules to CHIP program posted in Texas Register, June 27, 2003
CHIP Rules Adopted Effective August 29, 2003
| Texas Admin. Code Citation | CHIP Rules Changes | Effect of Change | Category of Change |
|---|---|---|---|
| 370.4 | Deleted definition of dental plan. | Eliminated dental benefits from CHIP. | Legislative Requirement |
| 370.4 | Deleted definition of income deductions that are applied against the gross income of a CHIP applicant. | Eliminated deductions in determining CHIP eligibility. | Legislative Requirement |
| 370.23 | Added a requirement that a child's Social Security number or proof of application for a number is required for the CHIP application to be considered complete. | Increased Burden on CHIP Applicants | |
| 370.23 | Requires applicants to provide information as to whether children have health insurance currently, or had health insurance within 90 days prior to the date of the application being completed for Medicaid. | Families must provide information required only for Medicaid eligibility for their CHIP applications to be considered complete. | Increased Burden on CHIP Applicants |
| 370.23 | Deleted the requirement that the CHIP applicant provide information as to whether he or she pays for child care or cares for a disabled adult in order to work. | Eliminated deductions in determining CHIP eligibility. | Legislative Requirement |
| 370.23 | Deleted the requirement that the CHIP applicant provide information as to whether any one pays child support or alimony. | Eliminated deductions in determining CHIP eligibility. | Legislative Requirement |
| 370.43 | Deleted the deduction of the first $50 of a family's monthly child support payments. | Eliminated deductions in determining CHIP eligibility. | Legislative Requirement |
| 370.43 | Imposed a gross income test instead of the net income limit. | Used gross income to determine CHIP eligibility instead of net income. | Legislative Requirement |
| 370.44 | Imposed an assets test for families with gross incomes above 150 percent of the federal poverty level. | Imposed an assets test for families with incomes above 150 percent of the federal poverty level. | Legislative Requirement |
| 370.44 | Eliminated a standard work-related expense deduction of $120 a month for each employed family member. | Eliminated deductions in determining CHIP eligibility. | Legislative Requirement |
| 370.44 | Eliminated a deduction for the actual costs of child care or for care of a disabled adult, up to a maximum of $200 for each child and $175 for each disabled adult. | Eliminated deductions in determining CHIP eligibility. | Legislative Requirement |
| 370.44 | Eliminated a deduction for the actual costs of alimony or child support paid to an individual who is not a budget group member. | Eliminated deductions in determining CHIP eligibility. | Legislative Requirement |
| 370.44 | Eliminated a deduction for the first $50 of child support payments received by the applicant's family. | Eliminated deductions in determining CHIP eligibility. | Legislative Requirement |
| 370.46 | Imposed a 90-day waiting period before the start of health insurance coverage for a child determined to be eligible for CHIP. | Imposed a 90-day waiting period before the CHIP health insurance would start, after determining a family is eligible for CHIP. | Legislative Requirement |
| 370.307 | Imposed a continuous enrollment period for six months instead of 12 months. | Imposed an enrollment period for six months instead of 12 months. | Legislative Requirement |
| 370.321 | Imposed a monthly premium. | Increased family CHIP costs. | Legislative Requirement |
Sources: Health and Human Services Commission and Texas Register.
2005 Changes to Eligibility, Procedures and Contractor Requirements HHSC Rules
Proposed rules to CHIP program posted in Texas Register, October 14, 2005; final rules published December 23, 2005
| Texas Admin. Code Citation | Policy and Rules Changes that increased the number of denials of CHIP coverage | Effect of Change | Category of Change |
|---|---|---|---|
| 370.4 | Changed definition of "budget group" to be the group of individuals who live in the home for whom an application for health care coverage is submitted. | Students older than 18 who are living at home while attending school are excluded from the family. Family size decreases, which means that it is more difficult to qualify for CHIP even though income levels have not changed. | Rule Change: Reduced Eligibility |
| 370.24 | Deleted the provision that, within three working days from receipt of an application, TexCare enters the application, regardless of origin or completeness, into a database; date-stamps the application; and assigns a unique application identification number. | Deleted this subsection. Adopted HHSC rules state that this section is obsolete. | Rule Change: Eliminated Contractor Performance Standards from State Rules |
| 370.25 | Deleted requirement that HHSC or designee sends a followup letter requesting missing information within two working days from the date that the application is entered into the database. | Rule Change: Eliminated Contractor Performance Standards from State Rules | |
| 370.25 | Allows HHSC or designee to state a deadline by which missing information must be provided, and allows HHSC to deny the application by the deadline if the information is not provided. | Adopted rules state that changes are being made to 370.25 to expedite the application process. HHSC in adopted rules said that the deadlines are stated in the notices and that it will also be stated in CHIP policy and business rules. | Rule Change: Increased Burden on CHIP Applicants |
| 370.25 | Reduced the time period that an application could be open from 90 days to 60 days. | Adopted rules state that the 60 day timeframe is to align CHIP policy with Medicaid policy under integrated eligibility. This provision shortened the time that an applicant can act in providing information. | Rule Change: Increased Burden on CHIP Applicants |
| 370.25 | Deleted the provision that an application with missing information remains active for 90 days. | Rule Change: Increased Burden on CHIP Applicants | |
| 370.25 | Added a provision that HHSC will certify or deny an application no later than 45 days from the application file date. | Previously, contractor had to decide the case in 30 days. This lengthens the time for the contractor to act, but shortened the time for an applicant to act. | Rule Change: Increased Burden on CHIP Applicants |
| 370.25 | Deleted requirement that contractor must send a second followup letter within 14 calendar days if the contractor has not received the missing information. | Rule Change: Eliminated Contractor Performance Standards from State Rules | |
| 370.25 | Deleted requirement that contractor must mail an application to the applicant if it is only missing the signature. | Rule Change: Eliminated Contractor Performance Standards from State Rules | |
| 370.40 | Deleted the provision that CHIP eligibility is determined not later than the 30th day after the date a complete application is submitted, unless the child is referred for a Medicaid application. | Rule Change: Eliminated Contractor Performance Standards from State Rules | |
| 340.42 | Deleted the provision that the applicant states the child's birth date on the application form and that verification of age is not required. | Adds an additional verification requirement that could lead to "missing information." | Rule Change: Increased Burden on CHIP Applicants |
| 370.43 | Deleted the provision that if the applicant states that a child is a United States Citizen and a Texas resident, no verification of this status is required. | Could be another reason for "missing information" and thus denial of a CHIP application. | Rule Change: Increased Burden on CHIP Applicants |
| 370.44 | Deleted the deduction for business expenses from self employment income. | Raises the threshold for CHIP eligibility. | Rule Change: Reduced Eligibility |
| 370.44 | Added the requirement that interest income is counted as part of unearned income and is counted in determining CHIP eligibility. | Raises the threshold for CHIP eligibility. | Rule Change: Reduced Eligibility |
| 370.44 | Deleted a provision that would allow a copy of a divorce decree to be sufficient for proof of child support payments. | Could be another reason for "missing information" and thus denial of a CHIP application. | Rule Change: Increased Burden on CHIP Applicants |
| 370.45 | Changes procedures so that children are tested first for Medicaid eligibility, and then CHIP eligibility. | Medicaid eligibility requires additional screening. TAA said that they have been doing a manual override for screening income first, then determining whether to screen for CHIP or Medicaid. | Rule Change: Increased Burden on CHIP Applicants |
| 370.48 | Deleted deadlines for the contractor's actions on transferring the application for Medicaid eligibility determination. | Rule Change: Eliminated Contractor Performance Standards from State Rules | |
| 370.51 | Changed the deadline for an applicant to request a review of an action from 30 working days from the date that the applicant received written notice of the decision to 30 working days from the date of the action. | If the contractor does not notify the applicant on a timely basis, this reduces the time an applicant can request a review. | Rule Change: Increased Burden on CHIP Applicants |
| 370.52 | Reduced the time that an applicant can request reconsideration of a review from 20 days to 15 days. | Rule Change: Increased Burden on CHIP Applicants | |
| 370.54 | Deleted the provision that would temporarily enroll a child in CHIP if there is factual information that could have an impact on an eligibility decision review, and substituted a provision that would allow, rather than require, HHSC to temporarily enroll. | Rule Change: Increased Burden on CHIP Applicants | |
| 370.307 | Adds exceptions to a continuous enrollment period, include one that would allow HHSC to direct a member's disenrollment if there is evidence that the member's original eligibility determination was incorrect. | Rule Change: Increased Burden on CHIP Applicants | |
| 370.309 | Removed the timeframes (14 calendar days) in which HHSC or the contractor must send out reminder packets to sign, return or complete enrollment forms. | Rule Change: Eliminated Contractor Performance Standards from State Rules | |
| 370.321 | Replaced the CHIP monthly premium with an enrollment fee. | Legislative requirement | Legislative Requirement |
| 370.401 | Established 12-month CHIP eligibility for an unborn child. (This provision does not add to chip caseload decline.) | Legislative requirement | Legislative Requirement |
| Required CHIP applicants to submit documents that validate family income on renewal applications. | Policy Change Adopted without Public Rule-Making Process | ||
| Omitting family income and asset information from CHIP renewal applications that have other information prepopulated. | Policy Change Adopted without Public Rule-Making Process | ||
| Requiring new data broker checks to be applied on all new CHIP applications and renewals. | Policy Change Adopted without Public Rule-Making Process |
Note: Most rule changes were effective Jan. 1, 2006.
New enrollment fees for new CHIP applicants were effective Jan. 1, 2006, and fees for renewing families were effective March 1, 2006. Verification of income and using a data broker were implemented for renewing families with March CHIP enrollment.
Sources: Health and Human Services Commission and Texas Register.