WAG 06-08-02-a: Nonfinancial Eligibility Requirements

PM 06-08-02-a

For Premium Level 2, families do not have to provide proof that their children are uninsured. HFS conducts post enrollment matching with most insurance companies to verify what families report at application about insurance. If there is a discrepancy with the match, families may have to provide proof of the coverage end date.

(FCRC/All Kids Unit)

  • Reviews clearances to confirm that a child lost Family Health Plan coverage within a year.
  • Accepts the family's statement regarding COBRA coverage and end date of insurance due to job loss or that the noncustodial parent canceled it as part of a divorce.

(FCRC/All Kids Unit)

Use TA 05/TAR 19 to deny a child who is in a mental health facility.

new textChild With Special Health Care Need

If the applicant reports that the child is pregnant, or is chronically or seriously ill and informs you of the child's condition, waive the requirement that the child must be uninsured for at least 90 days only for the child who has the special health care need. Document the reason in case comments. Proof of the health condition is not required.

new textNote: Until IES is revised to show this as a separate exemption reason, select "Child has special Health care needs" under the reasons why the insurance ended where it is listed as a drop down value.