Your CHIP Eligibility Determination Letter, Explained

“The State must provide each applicant or enrollee with timely and adequate written notice of any decision affecting his or her eligibility, including an approval, denial or termination, or suspension of eligibility, consistent with §§ 457.315, 457.348, and 457.350.”

“The notice must be written in plain language; and accessible to persons who are limited English proficient and individuals with disabilities, consistent with § 435.905(b) of this chapter and § 457.110.”

“The basis and effective date of eligibility;”

“The circumstances under which the individual must report and procedures for reporting, any changes that may affect the individual's eligibility;”

“Basic information on benefits and services and if applicable, any premiums, enrollment fees, and cost sharing required, and an explanation of how to receive additional detailed information on benefits and financial responsibilities; and”

“Information on the enrollees' right and responsibilities, including the opportunity to request a review of matters described in § 457.1130.”

“In the case of a suspension or termination of eligibility, the State must provide sufficient notice to enable the child's parent or other caretaker to take any appropriate actions that may be required to allow coverage to continue without interruption.”

“The State must accept a determination of eligibility for CHIP from the Medicaid agency in the State.”