Section 3 .us



Section 3.0

Application Maintenance

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3.0 APPLICATION MAINTENANCE 3

3.1 Application / Individual Search 7

3.2 Manage Application 10

3.2.1 Application 11

3.2.1.1 Table 1 – Citizenship Verification 19

3.2.2 Other Relationships 30

3.2.3 Income 33

3.2.4 Expenses 38

3.2.5 Insurance 40

3.2.6 SQI 46

3.2.7 Race & Ethnicity 49

3.2.8 PCP 50

3.2.9 Comments 53

3.3 APPLICATION MAINTENANCE FAQs 55

3.3.1 Household Status 55

3.3.2 Application Unit Size 56

3.3.3 Adding PCPs to an Individual 57

3.3.4 Changing PCPs 58

3.3.5 Add-a-Child Rule 59

3.3.6 Incomplete Applications 60

3.3.7 Status and Incomplete Reasons 61

3.3.8 Retro-Enrolls 62

3.3.9 Terminations 63

3.0 APPLICATION MAINTENANCE

Users will click on the Application Maintenance tab to open the Application Maintenance screen. Application Maintenance allows users to support the ongoing data management of a CHIP and/or adultBasic application.

There are three fundamental components of Application Maintenance:

1. The Search process allows users to find established applications and individuals

2. The Manage Application process allows user to make on-going changes to application and individual information

3. The Manage Transfer process allows users to transfer applications between contractors. Please refer to Section 6.0 for details on Transfers.

4. The Manage Alerts process allows users to input parameters for which to search for system alerts. Please refer to Section 11.0 for details on Alerts.

Initial Application Maintenance Screen

After logging into the CAPS system and clicking the Application Maintenance tab, the user is presented with the Search screen. Please refer to Section 3.1 for details.

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Application Maintenance Screen

Once the Search process is completed, the user is presented with the Manage Application screen.

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There are three Menu Items (hyperlinks) specific to the Application Maintenance. The Menu Items are:

1. Manage Application – enables the CAPS user to add, delete or change information in established applications. This information includes Application, Other Relationships, Income, Expenses, Insurance, SQI, Race & Ethnicity, PCP, Comments and Eligibility.

2. Manage Transfers – enables the CAPS contractors to transfer applications among contractors. Managing this transfer process involves interaction between the involved contractors and it includes both manual and automated processes. Please refer to Section 6.0 for details.

3. Manage Renewal – enables the CAPS users to streamline processing of renewal applications through this quick link. Users can access suspended renewal applications that is stored in a temporary holding area until the renewal form has been submitted by the user.

4. Manage Alerts – enables the CAPS users to input parameters for which to search for system alerts. Users can search on 3 types of alerts; System Action Pending, Worker Action Required, and Information. Two types of alerts are generated; Address and Income change alerts. In certain situations address changes and income changes may generate an alert. Please refer to Section 11.0 Alerts for details.

Basic Navigation

Users will find common Action Buttons on the CAPS Application Maintenance screens. These action buttons deliver consistent results regardless of the screen functionality. The Action Buttons are as follows:

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3.1 Application / Individual Search

Users have two options to get to the Search screen from the Home page within CAPS.

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Screen View Search Screen

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Note: Based on the search criteria, multiple records may be returned. If there are more than 50 records found based on the search criteria, CAPS will return only the first 50 records. The search criteria can be refined to locate the correct record.

The following data elements are captured on this screen and used as search criteria:

|Field |Description |Possible Values / Data Type |Interdependencies |

|Application Form ID |Identifies the Number that is printed on the |Not all contractors will include the Application form ID on |None |

| |application by the contractor |all forms | |

|UFI |Identifies the unique number assigned to an |Alpha numeric |None |

| |application |20 character length | |

|Contractor |Identifies the contractor’s name |Choose from list in drop down box |None |

|Application Status |Identifies the status that is assigned to the |Error in Submitting Application |None |

| |application based on the stage in the application|Ongoing Application | |

| |process |Pending AE Clearance | |

| | |Pending AM Clearance | |

| | |Submitted Application | |

| | |Suspended Application | |

| | |Archive | |

|UCI |Identifies the unique CAPS identifier assigned to|Alpha numeric |None |

| |an individual |20 character length | |

|Last Name |Identifies the last name of the individual |Alpha numeric |None |

| | |20 character length | |

|First Name |Identifies the first name of the individual |Alpha numeric |None |

| | |20 character length | |

|SSN |Identifies the Social Security Number of the |Numeric with 9 character length |None |

| |individual | | |

|Received Date |Identifies the date the application was received |MM/DD/YYYY |Cannot be a future date |

|(MM/DD/YYYY) | | | |

|Sales Representative |Identifies the sales representative that referred|Not all contractors have sales representatives involved in |Not applicable for all contractors |

| |the application |the CHIP/aB program | |

|Contractor ID |Identifies the number assigned by contractors |Alpha numeric with 20 character length |None |

| |when a SSN is not provided | | |

All of the applications that meet the criteria of the parameters supplied in the search request are presented to the CAPS user. If the CAPS user has the appropriate authority, they have the ability to either select the application or view a summary of the application’s data. Depending on the status of the application, the user will be taken to either Application Entry or Application Maintenance.

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3.2 Manage Application

Data that was captured as part of the Application Entry is available to be edited and viewed by the CAPS user in the Manage Application screen.

The Manage Application screen is divided into several functions. In order to navigate from one portion of the application to the next, a series of hyperlinks is provided along the top portion of the viewable application information area. These links are Application, Other Relationships, Income, Expenses, Insurance, SQI, Race & Ethnicity, PCP, Comments and Eligibility. Please refer to Section 4.0 for Eligibility details.

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Any updates made to an application update the CAPS database. The existing data contained within the tables affected by such updates is moved to a history record. The history of changes to the application can be accessed by clicking on the history button.

3.2.1 Application

Users will click the Application link to maintain Application information, Household information and Individual Detail information.

Screen View

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Application Information Screen View

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The following data elements are editable on this screen:

|Field |Description |Possible Values / Data Type |Interdependencies |

|Application Status |Indicates the current status of an |Ongoing Application | |

| |application (e.g., whether it is active or |Renewal Initiated | |

| |archived). |Archived | |

|Application Signed Date |Identifies the date the application was |MM/DD/YYYY |If “No”, the user should not enter the signature date |

| |signed | | |

|Signature? |Identifies if the application was signed? |Yes or No |If application is not signed, it is incomplete |

|Contractor |Indicates the contractor with whom the |Aetna |Pre-populated by CAPS |

| |application is currently assigned. |AmeriChoice | |

| | |CBC | |

| | |Highmark | |

| | |IBC | |

| | |NEPA | |

| | |Unison | |

| | |UPMC | |

|Application Source |Indicates the source of the application. |Aetna |Pre-populated by CAPS |

| | |AmeriChoice | |

| | |CBC | |

| | |COMPASS | |

| | |Highmark | |

| | |IBC | |

| | |BCNEPA | |

| | |Unison | |

| | |UPMC | |

|Sales Representative |Identifies the sales representative that |Choose from drop down box |None |

| |referred the application | | |

Household Information Screen View

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The following data elements are editable on this screen:

|Field |Description |Possible Values / Data Type |Interdependencies |

|Street Address |Identifies the applicant's physical address of |Alpha numeric |The first street address is a Mandatory field |

| |residency.  A second line is provided in case the |40 character length | |

| |address does not fit on the first line. | | |

|City |Identifies the city of the applicant's physical address|Alpha numeric |Mandatory field |

| | |30 character length | |

|State |Identifies the state in which the applicant physically |Select from alphabetical list if not |Mandatory field |

| |resides. |Pennsylvania | |

|Zip Code |Identifies the zip code of the applicant |Numeric |Mandatory field |

|County |Identifies the Pennsylvania county in which the |Choose from the drop down box |Mandatory field |

| |applicant resides | | |

|Home Phone |Identifies the home telephone number of the applicant |Alpha numeric |None |

| | |15 character length | |

|Work Phone |Identifies the work telephone number of the applicant |Alpha numeric |None |

| | |15 character length | |

| | | | |

|Best Time to Call |Identifies the best time the applicant is conveniently |Alpha numeric |None |

| |available |30 character length | |

|Which language do you |Identifies the language preferred by the applicant |English, Spanish, Other |None |

|prefer? | | | |

|Who is the head of |Identifies the application’s head of household |Choose from the list of individuals on the |Mandatory field. Must be an individual on the |

|Household? | |drop down box |application |

|Email Address |Identifies the email address for the head of household |Alpha numeric |None |

| | |50 character length | |

Individual Information Screen View

The Individual Information screen is used to review or edit Individual Demographic Information.

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The following data elements are editable on this screen:

|Field |Description |Possible Values / Data Type |Interdependencies |

|Last Name |Identifies the individual’s last name |Alpha numeric |Mandatory field. At least one (1) individual is |

| | |20 character length |required to apply. |

|First Name |Identifies the individual’s first name |Alpha numeric |Mandatory field. At least one (1) individual is |

| | |20 character length |required to apply. |

|MI |Identifies the individual’s middle initial |Alpha numeric |None |

| | |1 character length | |

|Applying? |Determines whether the individual is applying for |Yes or No |One individual is required. Is set to “No” during |

| |assistance | |nightly batch when an individual is terminated or |

| | | |denied. |

|Gender |Identifies the individual’s gender |Male |Mandatory Field. |

| | |Female | |

| | |Unknown | |

|Marital Status |Identifies the individual’s marital status |Married |None |

| | |Single | |

| | |Separated | |

| | |Divorced | |

| | |Widowed | |

| | |Other | |

|Birthdate |Identifies the individual’s birth date |MM/DD/YYYY |Mandatory Field: Used in determining the age of the |

| | | |individual. Age will determine whether the individual |

| | | |will be a CHIP or adultBasic applicant and is required |

| | | |for determining eligibility. Mandatory if the |

| | | |applicant is applying. If the applicant is not |

| | | |applying, make sure to answer the “student & under 19” |

| | | |question. This will ensure that the adult’s income |

| | | |will count towards eligibility. |

|SSN |Identifies the individual’s Social Security Number |Numeric with 9 character length. |SSN is the only attribute that will determine a 100% |

| | | |match during the clearance process. |

|Student under 19? |Defines whether or not the individual is a student under |Yes or No |Used in determining if income will be used during the |

| |the age of 19 | |eligibility determination process |

|Relationship? |Defines the relationships between all individuals in the |Choose from drop down list |One (1) and only one (1) person can be designed “Self” |

| |application. If there is only one individual in the | |in an application. If you select “Other”, an |

| |application, CAPS will assign the value of “Self”. | |additional field is provided to specify the |

| | | |relationship. |

|Application Origin |Indicates the manner in which an application was received |Direct Paper Form |Income Pilot options will be used by contractors |

| |by the contractor. |Direct Fax |providing service in Philadelphia County to indicate |

| | |Help Line |applications referred from a CAO that were |

| | |CAO |participating in the DPW self-declaration of income |

| | |COMPASS Client Entry |pilot. |

| | |Income Pilot – PCCY | |

| | |Income Pilot – Temple |The field is cleared when an individual’s applying |

| | |Income Pilot – HC 9 |switch is changed to “yes”. |

| | |Special Care | |

| | |Conversion | |

| | |Transition from Special Care | |

| | |CHIP Sticker/Xerox App | |

| | |Philadelphia Family Court | |

| | |CAO e-referrals | |

|Citizenship? |Defines the individual’s current citizenship status |US Citizen |Mandatory field: Required to move off of the page. |

| | |Temp. Alien | |

| | |Perm Resident | |

| | |Refugee | |

| | |Illegal Alien | |

|Citizenship Verified |Supplied verification of the citizenship status |Client Statement |Mandatory field: Must be entered as verification for |

| | |Collateral Contact |the citizenship status. *See Table below for |

| | |Document in Record |interdependencies. |

| | |Electronic Referral | |

| | |Not Required | |

| | |Verification Pending | |

| | |Worker saw document | |

|PA resident for 90 days? |Defines the individual’s Pennsylvania residency status |Yes or No |None |

|If no, date person became a |Identifies the date the individual became a Pennsylvania |MM/DD/YYYY |None |

|resident |resident | | |

|Has PA 162? |Identifies if the individual received a Medicaid Denial |Click once for Yes, leave blank for No |Please follow the Policy and Procedure Manual when |

| |Form for Public Assistance | |checking PA 162. A PA 162 is only considered for an |

| | | |applicant’s eligibility determination in Intake Mode. |

|Received Date |Identifies the date the application was received |MM/DD/YYYY |Mandatory field |

|Application Form ID |Identifies the number that is printed on the application | |None |

| |by the contractor | | |

|Perform Clearance |Forces clearance to run on this individual | |Please refer to Application Entry Users Guide Section |

| | | |2.2 for further details |

|Entry Date |Identifies the date the application was entered in CAPS |MM/DD/YYYY |Mandatory field that is populated with the current |

| | | |date. Field may be modified by the user. |

| | | | |

| | | |The field is cleared when an individual’s applying |

| | | |switch is changed to “yes”. |

|Missing information provided |Identifies the date all non-financial information was |MM/DD/YYYY |None |

|date |provided for an incomplete application | | |

|Completion Date |Identifies the date the application was completed |MM/DD/YYYY |This field is populated by CAPS based on the greatest |

| | | |of the application received date, application signature|

| | | |date, verification dates, and eligibility requirements.|

| | | |When entering a renewal, do not delete or re-enter a |

| | | |new completion date. When re-applying (i.e. there is a|

| | | |break in coverage), the completion date field on this |

| | | |screen must be blank and CAPS will enter a new date. |

|Household Status |Defines whether or not that individual is currently living|Present or Not Present |You cannot change the Household Status to Not Present |

| |in the household | |unless the applicable individual was denied or |

| | | |terminated. In addition, the individual designated as |

| | | |Head of Household cannot have a Household Status of Not|

| | | |Present. |

|Deceased? |Identifies if the individual is deceased |Yes or No |This field will be utilized when determining |

| | | |eligibility |

3.2.1.1 Table 1 – Citizenship Verification

|IS APPLYING AND IS PRESENT IN THE HH |  |

|Citizenship Status |Citizenship Verification |Allowed on |Complete/Incomplete |Reason code |

| | |Screen | | |

|US Citizen |Collateral contact |Y |Complete |  |

|  |Document in record |Y |Complete |  |

|  |Electronic Referral |Y(CAPS only) |Complete |  |

|  |Verification pending |Y |Incomplete |Inc. Rsn code 120: "Did not state citizenship status" |

|  |Client statement |Y |Complete |  |

|  |Not Required |N |n/a |  |

|  |Worker saw document |Y |Complete |  |

|Temporary or Illegal Alien |Collateral contact |Y |Denied |Failure Reason code 103: Citizenship (normal failure reason) |

|  |Document in record |Y |Denied | |

|  |Electronic Referral |Y(CAPS only) |Denied | |

|  |Verification pending |N |n/a | |

|  |Client statement |Y |Denied | |

|  |Not Required |N |n/a | |

|  |Worker saw document |Y |Denied | |

|Permanent/Resident Alien or |Collateral contact |N |n/a |  |

|Refugee | | | | |

|  |Document in record |Y |Complete |  |

|  |Electronic Referral |Y(CAPS only) |Complete |  |

|  |Verification pending |Y |Incomplete |Inc. Rsn code 139: "Need to provide proof of immigration status" |

|  |Client statement |N |n/a |  |

|  |Not Required |N |n/a |  |

|  |Worker saw document |Y |Complete |  |

|IS NOT APPLYING AND IS PRESENT IN THE HH |  |

|Citizenship Status |Citizenship Verification |Allowed on |Complete/Incomplete |  |

| | |Screen | | |

|US Citizen |Collateral contact |Y |n/a |Not applying individuals do not have an eligibility determination |

| | | | |and their citizenship status (or lack of it) does not make applying|

| | | | |individuals go incomplete. However, automated referrals must have |

| | | | |values. In the case where a non applying individuals status is not|

| | | | |on the application workers can select US Citizenship and Not |

| | | | |Required for verification. This will indicate, US citizenship is a |

| | | | |guess. DPW validates citizenship regardless of what we send them. |

|  |Document in record |Y |n/a | |

|  |Electronic Referral |Y(CAPS only) |n/a | |

|  |Verification pending |N |n/a | |

|  |Client statement |Y |n/a | |

|  |Not Required |Y |n/a | |

|  |Worker saw document |Y |n/a | |

|Temporary or Illegal Alien |Collateral contact |Y |n/a | |

|  |Document in record |Y |n/a | |

|  |Electronic Referral |Y(CAPS only) |n/a | |

|  |Verification pending |N |n/a | |

|  |Client statement |Y |n/a | |

|  |Not Required |Y |n/a | |

|  |Worker saw document |Y |n/a | |

|Permanent/Resident Alien and |Collateral contact |Y |n/a | |

|Refugee | | | | |

|  |Document in record |Y |n/a | |

|  |Electronic Referral |Y(CAPS only) |n/a | |

|  |Verification pending |N |n/a | |

|  |Client statement |Y |n/a | |

|  |Not Required |Y |n/a | |

|  |Worker saw document |Y |n/a | |

|IS NOT PRESENT (*applying switch does not matter) |  |

|Citizenship Status |Citizenship Verification |Allowed on |Complete/Incomplete |  |

| | |Screen | | |

|US Citizen |Collateral contact |n/a |n/a |The selection of Present in the HH is not an option during |

| | | | |Application Entry. |

| | | | | |

| | | | |During Application Maintenance, if a worker enters edit mode |

| | | | |citizenship and citizenship verification are not enterable fields. |

| | | | |However, on renewal page Not Present individuals do have these |

| | | | |fields opened in edit mode. AM will be modified to perform same as|

| | | | |renewal page. |

|  |Document in record |n/a |n/a | |

|  |Electronic Referral |n/a |n/a | |

|  |Verification pending |n/a |n/a | |

|  |Client statement |n/a |n/a | |

|  |Not Required |n/a |n/a | |

|  |Worker saw document |n/a |n/a | |

|Temporary or Illegal Alien |Collateral contact |n/a |n/a | |

|  |Document in record |n/a |n/a | |

|  |Electronic Referral |n/a |n/a | |

|  |Verification pending |n/a |n/a | |

|  |Client statement |n/a |n/a | |

|  |Not Required |n/a |n/a | |

|  |Worker saw document |n/a |n/a | |

|Permanent/Resident Alien and |Collateral contact |n/a |n/a | |

|Refugee | | | | |

|  |Document in record |n/a |n/a | |

|  |Electronic Referral |n/a |n/a | |

|  |Verification pending |n/a |n/a | |

|  |Client statement |n/a |n/a | |

|  |Not Required |n/a |n/a | |

|  |Worker saw document |n/a |n/a | |

|*Enrolled individuals that have the Present in HH switch changed from Yes to No are terminated for per clients request. |

Clearance

The user starts the Clearance process either by selecting the Perform Clearance checkbox or by updating key individual demographic information (i.e. SSN, date of birth, name, etc.) on the edit Individual Information screen. The Perform Clearance check box is not shown for an individual whose household status is currently Not Present. Clearance begins by performing a series of checks on the initial demographic data. This series of checks includes examining the name, SSN, gender, and date of birth. For each of the potential matches in the database, the matches are assigned a score based upon how closely they match the data for the individuals supplied to this process.

A series of checks first examines the individuals’ first and last names against names in the database:

• The names are first checked against a “nickname” table to identify if the names provided are commonly identified nicknames.

• Standardize the names that are processed through a specialized procedure to provide potential matches for names in the database that actually sound like or are pronounced in a similar fashion.

o This procedure is referred to as a SOUNDEX routine, in which the name is translated into an alphanumeric code representing the way the name sounds.

• Similar sounding names will produce similar alphanumeric codes, thus generating a potential match.

• Potential matches in the database are assigned a score based on how closely they match the data for the individuals on the application.

• If there is a 100% match however the first names do not match, CAPS will display a warning message to the user if the user tried to elect to match the individuals.

The result of the clearance process is a score indicating how closely the individual’s demographic information matches existing entries in the database.

• Scores above a certain threshold are identified as potential matches and displayed to the user through the Resolve Potential Duplicates process.

• If no potential match is found, or if the score is below the pre-defined threshold, a new UCI (Unique CAPS Identifier) is established.

Screen View

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The following options may be presented to the user after the clearance process is executed:

1. Use Match

Determine whether or not the information available as part of the new application is more reliable than the data that already exists for that person. Compare the new application data to the data that is in the system by:

• Clicking on the potential matched individual’s name (it will be hyperlinked).

o The user does not have access to view that individual’s data if the name is not hyperlinked.

o Coordination with the current contractor is necessary to determine which set of information is the most recent.

o A new web screen is opened in a new web browser with a consolidated view of the application of which the individual is currently a member.

o Close the web browser after comparing the data.

• If the data that already exists in the system is more reliable than the current data, or is very similar, select the “Use Match” option next to the matching individual. This will default all of the data associated with that individual on the Individual Detail Information screen.

2. Use Source

Determine whether or not the information available is more reliable than the data that already exists for that person. Compare the data to the data that is in the system by:

• Clicking on the potential matched individual’s name (it will be hyperlinked).

o The user does not have access to view that individual’s data if the name is not hyperlinked.

o Coordination with the current contractor is necessary to determine which set of information is the most recent.

• A new web screen is opened in a new web browser with a consolidated view of the application of which the individual is currently a member.

o After comparing the data, close the web browser.

• If the data that already exists is old, or very different than the current application data, select the “Use Source” option next to the matching individual.

• The user will be taken to the Individual Information Details screen once all of the potential matches have been resolved.

3. Update Individual

Review the information available to determine whether or not the individual exists or is new to the system. Compare the data to the data that is in the system by:

• Clicking on the potential matched individual’s name (it will be hyperlinked).

o The user does not have access to view that individual’s data if the name is not hyperlinked.

o Coordination with the current contractor is necessary to determine if the individual is new to the system.

• A new web screen is opened in a new web browser with a consolidated view of the application of which the individual is currently a member.

o After comparing the data, close the web browser.

• If it is determined that the individual is new to the system and does not match any of the potential matches displayed, select the “Update ” option.

• The user will be taken to the Individual Information Details screen once all of the potential matches have been resolved.

Remember:

• If there is a 100% match on the individual’s Social Security Number, the user cannot establish the individual as “New”.

• A user can always match an individual when sharing that individual across contractors even if the individual is the head of household/self and applying in both applications.

• When sharing an individual across contractors, all individual information will be consistent across applications. Household information will be specific to each application.

• An individual cannot be a part of two applications if both applications are with the same contractor.

• If an individual is shared across applications, each contractor can view the individual information. If the individual’s information is changed by one contractor, CAPS does not automatically inform the remaining contractor of the change except in certain cases when generating alerts. Please refer to the section 11.0 on Alerts for details on the certain circumstances when CAPS will automatically inform the remaining contractor of the change.

• If there is a 100% match however the first names do not match, CAPS will display a warning message to the user if the user tried to elect to match the individuals.

EXAMPLES:

Application Maintenance Clearance – Updating an Individual on an Existing Application

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|Fields |Within the Same Contractor | Across Contractors |

|Use Match |CAPS replaces the source individual’s data with the matched individual’s data on the |CAPS replaces the source individual’s data with the matched |

| |Application Maintenance screens. The matched individual’s data becomes the current |individual’s data on the Application Maintenance screens. The matched |

| |information |individual’s data becomes the current information |

| |CAPS removes the matched individual from his or her UFI |CAPS shares the matched individual’s data across contractors; the |

| | |individual can be enrolled in only one contractor |

|Use Source |CAPS replaces the matched individual with the source individual’s data on the |CAPS replaces the matched individual with the source individual’s data |

| |Application Maintenance screens. The source individual’s data becomes the current data |on the Application Maintenance screens. The source individual’s data |

| |CAPS removes the matched individual from his or her UFI |becomes the current data |

| | |CAPS shares the source individual’s data across contractors; the |

| | |individual can be enrolled in only one contractor |

|Update individual |Continue updating information for the source individual – no match is made |N/A |

Application Maintenance Clearance – Adding a New Individual to an Existing Application

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| Field |Within the Same Contractor | Across Contractors |

| |CAPS uses the existing individual (Match) UCI number and defaults his or her most current data | |

| |on the Application Maintenance screens, including income | |

| |The matched individual’s history data, eligibility status and renewal due date also defaults on | |

|Use Match |the source application | |

| |CAPS removes the matched individual from his or her UFI, and puts him or her in the source UFI | |

| | |CAPS uses the existing individual (Match) UCI number and defaults his or her|

| | |most current data on the Application Maintenance screens, including income |

| | |The matched individual’s history data also defaults on the source |

| | |application |

| | |CAPS shares the individual information across the contractors; the |

| | |individual can be enrolled in only one contractor |

|Use Source |CAPS uses the existing individual (Source) UCI number and does not default the matched |CAPS uses the existing individual (Source) UCI number but does not default |

| |individual’s data on the Application Maintenance screens |the matched individual’s data on the |

| |The matched individual’s current data will go to HISTORY on the source application |Application Maintenance screens |

| |CAPS removes the matched individual from his or her UFI, and puts him or her in the source UFI |The matched individual’s current data will go to HISTORY on the source |

| | |application |

| | |CAPS shares the individual information across the contractors; the |

| | |individual can be enrolled in only one contractor |

|Is a new individual |Creates a new individual – no match is made |N/A |

If the user selects a match during clearance, CAPS has logic that will look at the new application requesting switch and compare it to the existing application requesting switch. The matrix below explains what happens:

|New App Requesting |Existing App |What happens |

| |Requesting | |

|Yes |Yes |CAPS uses Yes |

|Yes |No |CAPS uses Yes |

|No |No |CAPS uses No |

|No |Yes |CAPS looks at current eligibility. If Denied/Denied- CAO Referral or Term/Term-CAO|

| | |Referral, then No. If anything other than Denied/Denied- CAO Referral or |

| | |Term/Term-CAO Referral, then Yes. |

3.2.2 Other Relationships

Users will click the Other Relationships link to maintain Stepparent Information and Absent Parent Information. This information is not used to determine eligibility.

Screen View

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Screen View Stepparent Information

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The following data elements are captured on this screen:

|Field |Description |Possible Values / |Interdependencies |

| | |Data Type | |

|Stepparent’s name |Identifies the stepparent |Choose from list in the drop down box |Must be an individual on the application. Cannot be the same name|

| | | |as “Name of the Child”. |

|Name of the child |Identifies the child of the stepparent |Choose from list in the drop down box |Must be an individual on the application. Cannot be the same name|

| | | |as “Stepparent’s Name” |

Screen View Absent Parent Information

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The following data elements are editable on this screen:

|Field |Description |Possible Values / |Interdependencies |

| | |Data Type | |

|Absent Parent’s Last Name |Identifies the last name of the absent parent |Alpha numeric |If an absent parent is identified, you must select at least one|

| | |20 character length |(1) individual from “Which child is/was this parent responsible|

| | | |for?” |

|Absent Parent’s First Name|Identifies the first name of absent parent |Alpha numeric |None |

| | |20 character length | |

|Deceased? |Is the absent parent deceased? |Yes or No |None |

|Absent Parent’s Street |Identifies the permanent street address of absent |Alpha numeric |A second line is provided in case the address does not fit on |

|Address |parent |40 character length |the first line |

|City |Identifies the city where the absent parent resides |Alpha numeric |None |

| | |30 character length | |

|State |Identifies the state where the absent parent resides |Choose from list in the drop down box |None |

|Zip Code |Identifies the zip code of the absent parent |Alpha numeric |None |

| | |5 character length | |

|Date of Birth (MM/DD/YYYY)|Identifies the date of birth of absent parent |MM/DD/YYYY |None |

|SSN |Identifies the Social Security number of absent |Numeric |None |

| |parent | | |

|Which child is/was the |Specifically names the child/children the absent |Check the child that the absent parent is |None |

|parent responsible for? |parent was responsible for |or was responsible for | |

3.2.3 Income

Users will click the Income link to maintain Income Details Information and Employment Information.

Screen View

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Screen View Income Details

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Screen View Income Details with Fluctuating Income

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Screen View Income History

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Note: An Income instance defines a unique occurrence of Income. If an individual has multiple jobs or has a new income type, Add a new income instance. If an individual’s Gross Amount per Payment has changed, Edit the current income instance. If the source of the income has changed, you should Delete the original instance and add a new type. The Income Details section should only be edited if a mistake had been made in recording the income information in CAPS or if existing income information needs to be updated.

The following data elements are editable on this screen:

|Field |Description |Possible Values / Data Type |Interdependencies |

|Income Type |Defines the income type |Child Support/Alimony |If Income type is “Wages, Commissions and Bonus”, then |

| | |Interest and Dividends |Employment Information (Name, Number of Hours Worked per |

| | |Other Earned |Month, Number of Months for Standard Deduction) must be |

| | |Other Unearned |completed |

| | |Public Assistance | |

| | |Rental Property Earned | |

| | |Rental Property Unearned | |

| | |Retirement Benefits | |

| | |Self Employment | |

| | |Social Security Benefits | |

| | |Supplemental Security Income (SSI) | |

| | |Unemployment | |

| | |Wages, Commissions and Bonus | |

| | |Worker’s Compensation | |

| Employer Name (If |Identifies the name of the |Alpha numeric |None |

|employed) |individual’s employer related to the |40 character length | |

| |instance of income | | |

|How often is the income |Identifies the frequency that this |Every Two Months, Every Two Weeks, Monthly, Once a Year, One |Determining factor in the number of payments per year |

|received? |instance of income is received. |Time Only, Quarterly, Twice a Year, Twice per Month, Unknown,|calculation. Required if the income is verified. |

| | |Weekly | |

|Number of Payments per |Identifies the number of times this |This field is automatically calculated based on “How often is|This number is used when determining the annual amount of |

|year |payment is received in a calendar |the income received?” |this income. Required if the income is verified. |

| |year. | | |

|Do you have fluctuating |Answer yes if the gross amount per |Yes or No |Used when there is fluctuating income in averaging the |

|income? |payment varies | |different payment amounts |

|Gross Amount per Payment |Indicates the amount of income that |Numeric. This amount is calculated if there is fluctuating |None |

| |is received for an instance of income|income. If income is not fluctuating, the user enters the | |

| |before taxes or any other deduction |actual amount | |

|Payment Amounts |Defines the fluctuating gross amount |Numeric |Used when an applicant has fluctuating income. Eight (8) |

| |payments | |amounts are available to determine Gross Amount per |

| | | |Payment |

|Income Verified? |Indicates whether or not proper and |Yes or No |Mandatory field. If “Yes”, “Verified Date” must be |

| |sufficient documentation has been | |completed. Used in determining eligibility |

| |provided to verify the reported | | |

| |income | | |

|Verified Date |Identifies the date when the income |MM/DD/YYYY |If the date the income was verified is June 1 but the data|

| |was verified | |entry date is June 10, use the June 1 date |

|Annual Amount |Identifies the annual income amount |Numeric. This field is calculated automatically |Number of payments per year multiplied by gross amount per|

| | | |payment. Used in determining eligibility |

Screen View Employment Information

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The following data elements are editable on this screen:

|Field |Description |Possible Values / |Interdependencies |

| | |Data Type | |

|Number of Hours Worked per |Identifies the sum of all the hours an |Numeric |If Income Type is: “Wages, Commissions and Bonus” this |

|Month |individual works on average in a month. | |field should be filled in. |

|Number of Months for Standard|Identifies the number of unique months a |Numeric |Cannot exceed 12 for an individual |

|Deduction |person works in a given year | | |

3.2.4 Expenses

Users will click the Expenses link to maintain Dependant Care Expense Information and Transportation Expense Information.

Screen View

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Screen View Dependant Care Expenses

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The following data elements are editable on this screen:

|Field |Description |Possible Values / |Interdependencies |

| | |Data Type | |

|Name of the Child or Disabled Adult |Indicates the child or disabled adult who is receiving |Choose from list in the drop down box |Person must be a part of the |

| |dependent care expenses | |application |

|Number of Months for Deduction |Indicates the number of months that dependent care paid for in |Numeric |Cannot exceed 12 for an |

| |a calendar year | |individual; nor can be zero if an |

| | | |expense amount is entered. |

|Monthly Expense Amount |Identifies the monthly amount that is paid for the dependent |Numeric |None |

| |care | | |

|Annual Amount |Identifies the annual dependent care expense amount |Number of Months for Deduction multiplied by | |

| | |the Monthly Expense Amount | |

Screen View Transportation Expenses

[pic]

The following data elements are editable on this screen:

|Field |Description |Possible Values / |Interdependencies |

| | |Data Type | |

|How much does it cost to get to work each week if you|Identifies the weekly cost of transportation other than |Numeric |None |

|ride with another person or take a bus, subway, or |the use of personal vehicle | | |

|trolley? | | | |

|If you drive to work, how many miles do you drive |Identifies the number of miles in one week to get to work |Numeric |None |

|each week? |if the individual drives his or her own vehicle | | |

|If you have a car, how much is your monthly payment? |Identifies the monthly payment an individual makes on a |Numeric |None |

| |personal vehicle | | |

3.2.5 Insurance

Users will click the Insurance link to maintain Health Insurance Information, Health Insurance Details Information, Car Insurance Information and Health Insurance from you Employer Information.

Screen View

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Screen View Health Insurance

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The following data elements are editable on this screen:

|Field |Description |Possible Values / |Interdependencies |

| | |Data Type | |

|Has health insurance? |Answer “Yes” if the individual currently has health |Yes, No, Blank |None |

| |insurance | | |

|Had private health insurance in the |Answer “Yes” if the individual’s private health insurance |Yes, No, Blank |This question is not asked for CHIP |

|past 6 months days? |terminated within the past 6 months | |applicants (individuals under age 19). |

|Insurance End Date |Identifies the date that the private insurance was |MM/DD/YYYY |None |

| |terminated | | |

|Did the health insurance policy |Answer “Yes” if the health insurance policy holder lost |Yes, No, Blank |Yes will impact eligibility determination |

|holder lose employment? |employment | | |

|Have you been denied private health |Answer “Yes” if the individual has been denied health |Yes, No, Blank |None |

|insurance due to pre-existing |insurance due to pre-existing condition | | |

|condition? | | | |

Screen View Health Insurance Details

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The following data elements are editable on this screen:

|Field |Description |Possible Values / |Interdependencies |

| | |Data Type | |

|Insurance Company Name |Identifies the name of the insurance company that provided |Alpha numeric |None |

| |health insurance |100 character length | |

|Who holds this policy? |Identifies the individual on the application who holds the |Choose from the list in the drop down box |Individual must be on the application|

| |health insurance policy | | |

|Who is covered? |Check the individuals that are covered under the health | |None |

| |insurance policy | | |

|What is covered? |Identifies the types of services that are provided by the |Dental |To be considered for credible |

| |current health insurance |Drugs (Prescription) |coverage Doctor and Hospital must be |

| | |Hospital/Nursing Home Institution |selected |

| | |Medical Transportation | |

| | |No Medical Expense | |

| | |Physical Therapy | |

| | |Doctor/Outpatient | |

| | |Eye Care | |

| | |In-Home Care | |

| | |Insurance Premium | |

| | |Medicare Part B Premium | |

| | |Other | |

| | |Prosthesis | |

|Policy Number |Identifies the health insurance policy number of the individual|Alpha numeric |None |

| |who holds the policy |30 character length | |

|Group Number / Name |Identifies the group number or name that the policyholder |Alpha numeric |None |

| |belongs to |30 character length | |

|When did the insurance |Identifies the date the health insurance started for the |MM/DD/YYYY |None |

|start? |policyholder | | |

|When does this insurance |Identifies the date the health insurance ended for the |MM/DD/YYYY |None |

|stop? |policyholder | | |

Screen View Car Insurance

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The following data elements are editable on this screen:

|Field |Description |Possible Values / |Interdependencies |

| | |Data Type | |

|Insurance Company Name |Identifies the name of the company providing |Alpha numeric |None |

| |car insurance |50 character length | |

|Who holds this policy? |Identifies the Individual on application who |Choose from list in the drop down box |Policyholder must be in the application. If you |

| |holds the car insurance policy | |choose “Other”, you must provide the person’s name |

| | | |who holds the policy |

|Policy Number |Identifies the policy number for the insured |Alpha numeric |None |

| |individual |30 character length | |

|Policy Expiration Date |Identifies the date car insurance policy |MM/DD/YYYY |None |

| |expires | | |

Note: Car Insurance information is not used to determine eligibility.

Screen View Health Insurance from your Employer

[pic]

The following data elements are editable on this screen:

|Field |Description |Possible Values / Data Type |Interdependencies |

|Can you get health insurance for yourself through |Identifies if an individual can get health insurance at|Yes or No |None |

|your work? |their place of work | | |

|If yes, would the applicant have to pay for it? |Identifies if an individual would have to pay for |Yes or No |Displayed only if the previous question|

| |insurance at their place of work | |is answered “Yes” |

|Can you get insurance for your child through work?|Identifies if an individual can get health insurance |Yes or No |None |

| |for their children at their place of work | | |

|If yes, would the applicant have to pay for it? |Identifies if the individual would have to pay for |Yes or No |Displayed only if the previous question|

| |their child’s insurance | |is answered “Yes” |

|In the past 30 days, did anyone in the applicant’s|Identifies if anyone in the application lost a job in |Yes or No |None |

|family lose a job where they had health insurance?|the past 30 days and had health insurance | | |

Note: Health Insurance from your Employer data is not used to determine eligibility.

3.2.6 SQI

The user will click the SQI link to maintain Pregnancy Information, Disability Information and SSI Information.

Screen View

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Screen View Pregnancy

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The following data elements are editable on this screen:

|Field |Description |Possible Values / |Interdependencies |

| | |Data Type | |

|Name |Identifies the name of the pregnant individual in the |Choose from the list in the drop down |Individual must be included in the application. The |

| |household |box |application will only list females on the application. |

| | | |Answering “Yes” will affect eligibility determination. Please |

| | | |refer to Section 4.0 |

|Estimated Due Date |Identifies the estimated due date of the pregnant |MM/DD/YYYY |None |

| |individual | | |

Screen View Disability

The following data elements are editable on this screen:

|Field |Description |Possible Values / |Interdependencies |

| | |Data Type | |

|Name |Identifies the name of individual with |Choose from the list in the drop down box |Individual must be included in the application. This |

| |disability | |field will not effect eligibility |

|Have you applied for |Identifies if the individual has applied for |Yes or No |None |

|Disability Benefits? |disability benefits | | |

|What is the disability |Identifies the permanent physical or |Alpha numeric |Free text |

|condition? |psychological disability of the individual |150 character length | |

Screen View SSI

[pic]

The following data elements are editable on this screen:

|Field |Description |Possible Values / |Interdependencies |

| | |Data Type | |

|Name |Identifies the name of individual that |Choose from list in the drop down box |Individual must be included in the |

| |received SSI in the past | |application. This field does not effect |

| | | |eligibility |

|If SSI was stopped, was it because he or she |Confirms individual received Social Security |Yes or No |This field does not effect eligibility |

|began to get Social Security? | | | |

|If SSI was stopped, was it because he or she |Confirms individual received an increase in |Yes or No |This field does not effect eligibility |

|got an increase in Social Security? |Social Security | | |

3.2.7 Race & Ethnicity

Users will click the Race & Ethnicity link to maintain Race and Ethnicity Information. This information is not used to determine eligibility.

Screen View

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Alternate Screen View Race & Ethnicity

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The following data elements are editable on this screen:

|Field |Description |Possible Values / |Interdependencies |

| | |Data Type | |

|Race |Identifies the race of the individual |Check the appropriate race selection or add free form |None |

| | |text in “Other Race” | |

|Ethnicity |Identifies the ethnicity of the individual |Hispanic, Non-Hispanic, Blank |None |

3.2.8 PCP

Users will click the PCP link to maintain PCP Information. If the contractor has elected to provide a 274 file, then the lookup PCP feature will allow the user to search for the PCP selected from a list. Details of the selected PCP will then be populated back to the PCP edit page. This information is not used to determine eligibility.

Screen View

[pic]

Alternate Screen View PCP Information

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Alternate Screen View PCP Search

[pic]

The following data elements are editable on this screen:

|Field |Description |Possible Values / |Interdependencies |

| | |Data Type | |

|Applicant Name |Identifies the name of the individual who is listing physician |Choose from the list in the drop down box |None |

|Physician Last Name/Office |Identifies the last name of the physician or the Practice or |Alpha numeric |None |

| |Business name (if selection is set-up by that contractor) |60 character length | |

|Physician First Name |Identifies the first name of the physician |Alpha numeric |None |

| | |20 character length | |

|PCP Number |Identifies the PCP number of the physician |Alpha numeric |None |

| | |20 character length | |

|PCP Type |Identifies the PCP type |Physician or Dentist |None |

|Street Address |Identifies the street address for the physician’s office |Alpha numeric |None |

| | |40 character length | |

|City |Identifies the city for the physician’s office |Alpha numeric |None |

| | |30 character length | |

|State |Identifies the state of the physician’s office |Choose from list in the drop down box |If “State” is Pennsylvania, then Zip Code |

| | | |must be a valid Pennsylvania Zip Code |

|Zip Code |Identifies the zip code of the physician’s office |Alpha numeric |None |

| | |5 character length | |

|Current Patient |Identifies if the individual is a current patient |Yes or No |If “No”, the individual must fall in the |

| | | |“Serving Age Range” provided during the |

| | | |PCP search |

|Serving Age Range |Identifies the preferred age range that physician provides |Numeric |None |

| |medical attention | | |

|Currently Accepting New |Identifies if the provider is accepting new patients? |Yes or No |If “No”, you cannot select that doctor as|

|Patients? | | |the PCP |

3.2.9 Comments

Users will click the Comments link to maintain Comment Information. This information is not used to determine eligibility.

There is no spell check functionality in the Comments section. If you have a long comment, you may wish to enter the comment into Microsoft Word and perform a spell check. From Microsoft Word, you can copy (Ctrl-C) and paste (Ctrl-V) the comment into CAPS.

Comments are permanent once they have been saved and cannot be edited nor deleted. However, you may add additional comments to an individual.

Screen View

[pic]

The following data elements are editable on this screen:

|Field |Description |Possible Vales/Data Type |Interdependencies |

|Name |Identifies the name of individual that the comment is|Choose from list in the drop down box |Individual must be on the application |

| |about | | |

|Comment Type |Identifies the type of comment being made |Customer Inquiry | |

| | |Reported Changes | |

| | |Eligibility Changes | |

| | |PID Inquiry | |

| | |Legislative Inquiry | |

| | |Grievances | |

| | |Eligibility Review Documentation | |

| | |Application Entry | |

| | |Other | |

|Comments |Defines comments about the applicant or application |Alpha numeric |Comments are not editable. Users can add but|

| | |2000 character length |not change, delete or spell check the |

| | | |comments. |

3.3 APPLICATION MAINTENANCE FAQs

3.3.1 Household Status

3.3.1.1 Why can’t I change the Household Status to Not Present

You cannot change the Household Status to Not Present unless the applicable individual had an eligibility status of Denied or Terminated. In addition, the individual designated as Head of Household cannot have a Household Status of Not Present.

If the Head of Household is no longer in the household, do the following to change an individual to Not Present:

• Make a different individual in the application unit the “Self”

• Modify the relationships

• Modify the Head of Household to the new Self

• Change the household status of the previous Head of Household to Not Present

3.3.2 Application Unit Size

3.3.2.1 Increase/Decrease Application Unit Size

I was doing a redetermination on subsidized members (a family of four with 2 adults and 2 children) whose income now qualifies them for Free CHIP. During conversion, only one parent's name is listed in CAPS. I added the father's name and updated the income information. The Application Unit Size changed from 4 members to 5. Why? How do I change the applicant unit size back to 4?

In order to reflect the household size that the eligibility determination was based on, it was determined that the household size would be established in CAPS based on the data sent in the conversion load regardless of the number of individuals being sent over as part of the application.

Therefore, even though you may only have had 3 individuals on the application, the application unit size in CAPS is 4 because the household size is 4.

The Application Unit Size changed to 5 after you added the father to the application because CAPS always increases the family size by one when a person is added to the application. Since the converted family size already considered this individual, it changed the Application Unit Size from 4 to 5.

You can fix the application unit size by going into the Manage Application Unit functionality, changing the application unit size back to 4, and performing an online eligibility determination.

[pic] Found in section 4.1.5 of the CAPS User Guide.

3.3.3 Adding PCPs to an Individual

3.3.3.1 Can an individual have more than one PCP?

An individual cannot have more than one physician but may also have a dentist.

3.3.4 Changing PCPs

3.3.4.1 How do I change a PCP assignment?

Search for and select the application (UFI) that has the individual(s) whose PCP assignment you want to change (or search for the individual)

o Click PCP

o Click EDIT (located at the bottom left of your screen)

o For each individual whose PCP you want to change, click the red “X” located on the right side of the screen within the PCP assignment section of the individual

o For each individual whose PCP you want to add, do the following:

o Click the Add button

o Enter the PCP Number in the box under PCP Number

o If your organization has a list of PCP’s referenced within CAPS (i.e. Highmark, NEPA, IBC, Unison), click Lookup PCP

▪ If the PCP is found, review the information to verify the PCP information is correct, then click the SELECT button (the PCP detail information will be automatically populated on your screen for that individual)

▪ If the PCP is not found, follow your organization’s procedures for what to do when a PCP is not found in the PCP list

o Select YES or NO for the question labeled “Current Patient?”

o Provide the Effective Date

o The PCP Type is defaulted to Physician.  Leave it as-is, unless the PCP you are entering is a Dentist. If it is a Dentist, change the PCP type to “Dentist”

o Click the Save button

[pic] Found in section 3.2.8 of the CAPS User Guide.

3.3.5 Add-a-Child Rule

3.3.5.1 I added a child to an application and determined eligibility. When I looked at the eligibility details screen, the income range for this individual listed as “N/A.” Why?

In situations were an application has an enrolled Free CHIP child, and a second child is added, the added child will receive a “Free CHIP Pass.” If the added child passes the non-financial tests, he or she will receive enrollment in the CHIP program for the remaining months that the existing CHIP child has enrollment. The income range on the financial information of the Eligibility Details screen will say “N/A.” Both children will have to renew together, and at that time, CAPS will use income to determine both children’s eligibility.

3.3.6 Incomplete Applications

3.3.6.1 I did not receive an error when submitting my application. Why is my application incomplete?

It is possible to submit an application that does not contain all of the information needed in order to enroll an individual. You should still submit the application even if you do not have all the information so that CAPS will give an eligibility status of Incomplete. This status will generate a letter to the client and inform them of the information that is needed to complete the application.

3.3.7 Status and Incomplete Reasons

3.3.7.1 I determined the eligibility on an application; however, I noticed that both the Status Reasons and Incomplete Reasons on the individual summary screen are populated with “Information not found”. Does this mean that I am missing information on the application?

“Information not found” means that there is no Status and/or Incomplete reason codes for the given applicant(s). For example, if the Incomplete Reason is “Information not found”, then the application is deemed complete.

3.3.8 Retro-Enrolls

3.3.8.1 Am I allowed to retro-enroll someone prior to physically receiving the application?

This is an example of a policy question and should only be done in accordance with established policies and procedures. CAPS will allow you to set an enrollment begin date prior to the “Received Date”. Retro-enrollment prior to contractor’s received date may be warranted for special or emergency medical care situations. Setting the enrollment begin date prior to the received date facilitates the application determination process.

Retro-enrollment situations will be tracked via PID reports.

[pic] Found in section 4.1.7 of the CAPS User Guide.

3.3.9 Terminations

3.3.9.1 Deceased Individuals

If an individual dies, how do I capture the deceased information in CAPS? When I removed the individual from coverage, CAPS automatically set the termination date to three months after the date of death. Since there is not a Date of Death field in CAPS, what should I do so coverage ends the first of the month following the date of the individual’s death?

You can use the Manage Eligibility function in order to change the termination date. Click on the Manage Eligibility button under the Eligibility tab, enter the termination date and select “Adult Deceased” or “Child Deceased” from the Status Reasons field.

For the deceased applicant, you will also need to edit the applicant information in the Individual Information section of the application. Change the Deceased drop-down to “Yes” and the Household Status to “Not Present” for the individual and click “Save”.

If the deceased individual is the Head of Household, first change the Head of Household to an existing individual on the application, then change the relationships including the “Self.” After the relationships are updated, you can change the Deceased and Household Status fields.

You should then process eligibility for any remaining household members.

3.3.9.2 Moving Out of Household

Where do you go to terminate someone who is moving out of the household?

If the individual is still applying for benefits, a new application will need to be created. If the individual moved to a location that is outside your coverage area, you will need to contact the appropriate contractor.

If the individual is not applying for benefits, you can use the Manage Eligibility screen in order to terminate the individual. The Manage Eligibility screen allows for the capturing of the reason why the person is being manually terminated (i.e. applicant no longer in household) and the effective date of the termination. You will also need to edit the application information in the Individual Information section of the application. Change the Household Status to “Not Present” for the individual and click “Save”.

In either scenario, you should process eligibility for any remaining household members.

3.3.9.3 Non-payment of Premium

What should I do if an individual renews a Free CHIP application and become eligible for Sub CHIP, then does not pay his or her premium?

If the enrollee renewed from the Free CHIP subprogram and was determined eligible for a Subsidized CHIP subprogram or the At Cost CHIP subprogram, and does not pay an initial premium they will be terminated for non payment of initial premium and will potentially receive a 13th month of coverage depending upon when the renewal was completed relative to the renewal due date. If the renewal was completed up to 37 days prior to the renewal due date, they will not qualify for the 13th month extension of Free CHIP coverage. However, if the renewal is completed 37 days or less from the renewal due date, a 13th month will be extended to allow sufficient time for the premium to be received. Eligibility will calculate and display the individual’s potential subprogram. During the 13th month the child will remain enrolled in free CHIP with an eligibility status of Enrolled – ACR. By the end of the 12th or the 13th month if the child’s premium has not been received, CAPS will automatically terminate the child’s CHIP coverage.

3.3.9.4 Age out Process

How does CAPS determine the termination date for people that Age-out of CHIP and/or adultBasic?

An individual will be terminated the 1st of the month following the month the enrollee turns 19 or 65 years old.  In situations where the birth date has been modified (so that the individual is not within the age guidelines of the program) the individual will be terminated following the advance notice requirement, which would be the first of the month following 37 days. In addition, individuals whose 19th birthday falls in their effective month will be determined using adultBasic non-financial and financial rules.

-----------------------

UFI will carry forward on each screen

Manage Application

Head of Household will carry forward on each screen

Click to delete the current information

Click to add information regarding an individual

Click to save current information

Click to return to previous screen

Click to review historical audit of the data

Click to edit the current information

Click Application Maintenance tab

Click Search link

Click to reset all parameters

Click to execute search on the defined parameters

Click UFI link to Manage Application screen.

Click links for appropriate functions

Please refer to Section 6.0 for Transfers

Add fluctuating income amounts to determine Gross Amount per Payment

Income ID defines an instance of Income

Click to return to Edit Individual Information Screen

Please refer to Section 11.0 for Alerts

Source Individual

Matched Individuals

Matched Individual

Source Individual

Matched Individuals

Source Individual

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