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C-CHIP Frequently Asked Questions
PROGRAM HISTORY
- Who are the original C-CHIP Counties?
- Where can we get information on what was submitted in the original C-CHIP SPA?
SUBMITTING AN APPLICATION
- Will the application document be available electronically?
- How many copies of the application are required for submittal?
- How close to implementation does a county have to be in order to submit an application?
- Can a county present two options in an application, to possibly expedite the review process? (In case one option was rejected by CMS, MRMIB would not have to come back and start from scratch with the county.)
- Do capitation rates have to be included in the application?
- What information needs to be provided regarding C-CHIP contracts?
- Does the Health Plan have to be appropriately licensed for the county to qualify for C-CHIP?
- Can First 5 be a sponsor, since they are not explicitly named in Chapter 648, Statutes of 2001?
FUNDING
- Is it possible for the State to do a blanket SPA for all counties?
- How do local initiative funds become characterized as "county dollars"?
- Can "realignment" revenues be used?
- How far back can a County go in order to claim matching funds?
- Are the counties requesting funding for C-CHIP outreach?
- Can a County with a health plan that is not Knox-Keene licensed be eligible for C-CHIP funds?
GENERAL INFORMATION
- Has any thought been given to expanding HFP to 300% of FPL to include C-CHIP population or for the counties to come together and pursue it as unit?
- What kind of coordination will be required? Is it the same as HFP? Can Health-e-App be used?
- Can Health-e-App be used for renewals and/or referrals from Healthy Kids to Medi-Cal or HFP?
- What renewal information has to be submitted?
- What if the provider network is not in place at the time the application is submitted?
- With regard to plan benefits, if dental benefits are being provided as a direct service by the county (not an insurance product), could that be proposed as a deviation?
- Will Health-e-App screen children to Healthy Kids based on immigration status?
- Can the Healthy Kids program be split so that the First 5 Commission is administering the S-CHIP eligible program and have a separate entity administer the rest of the program?
- What if the County is anticipating setting a cap or establishing a waiting list?
- Does a separate administrative system have to be set up just for the C-CHIP program?
- Who are the original C-CHIP Counties?
- Where can we get information on what was submitted in the original C-CHIP SPA?
- Will the application document be available electronically?
- How many copies of the application are required for submittal?
- How close to implementation does a county have to be in order to submit an application?
- Can a county present two options in an application, to possibly expedite the review process? (In case one option was rejected by CMS, MRMIB would not have to come back and start from scratch with the county.)
- Do capitation rates have to be included in the application?
- What information needs to be provided regarding C-CHIP contracts?
- Does the Health Plan have to be appropriately licensed for the county to qualify for C-CHIP?
- Can First 5 be a sponsor, since they are not explicitly named in Chapter 648, Statutes of 2001?
Answer: The counties of Santa Clara, Alameda, San Mateo and San Francisco.
Answer: On the CMS web page at http://www.cms.hhs.gov
Answer: Yes. It is available on the MRMIB web site.
Answer: If an electronic copy is submitted, then it needs to be followed up with a hard copy with original signatures. If only hard copies are to be submitted, then submit one with original signatures and two copies.
Answer: If the county is at the stage of negotiating with a health plan, then they are far enough along to submit an application.
Answer: That would be a possibility, however the sponsoring entity has many responsibilities including contracting with MRMIB and administering all of the IGTs.
Answer: The capitation rates that will be identified in all contacts, including those for medical, dental, vision, and mental health, will have to be included in the application.
Answer: Applicants have to fully describe the relationships between counties, sponsors, funders, health plans, etc. For instance, with the original four counties they all ended up being the sponsor for their programs. MRMIB will need to know the relationship between the county and the provider of service, i.e. health plan.
Answer: Yes.
Answer: Chapter 648, Statutes of 2001 identified a County Agency, a Local Initiative (LIs), or a County Organized Health Systems (COHS) as an "applicant," however, the latter two have been eliminated by CMS.
- Is it possible for the State to do a blanket SPA for all counties?
- How do local initiative funds become characterized as "county dollars"?
- Can "realignment" revenues be used?
- How far back can a County go in order to claim matching funds?
- Are the counties requesting funding for C-CHIP outreach?
- Can a County with a health plan that is not Knox-Keene licensed be eligible for C-CHIP funds?
Answer: CMS is extremely concerned about the source of funding for each individual county, since it will be different in each case. This would preclude a blanket SPA approval.
Answer: Any money (from health plans or any other source) that may have been Federal to begin with, stays Federal and cannot be matched. Additionally, if a county is going to use General Funds, it must identify the tax funding source, in order to insure that they are not matching with Federal dollars.
Answer: The applying county will need to give a complete description of what has been "realigned" and what the original source of funds was. This would be subject to Federal review and approval
Answer: MRMIB received clarification from CMS that Federal claiming would be from the date the SPA was filed. There is a Federal regulation that addresses this and is related to the source of funds issue.
Answer: Yes, counties can claim up to10% of their benefit costs for administration and outreach. However, if you contract out outreach, you will need to thoroughly describe the process of who is conducting the outreach and outreach activities being conducted.
Answer: No. Health Plans must have Knox-Keene licensure to be eligible to participate in C-CHIP matching funds
- Has any thought been given to expanding HFP to 300% of FPL to include C-CHIP population or for the counties to come together and pursue it as unit?
- What kind of coordination will be required? Is it the same as HFP? Can Health-e-App be used?
- Can Health-e-App be used for renewals and/or referrals from Healthy Kids to Medi-Cal or HFP?
- What renewal information has to be submitted?
- What if the provider network is not in place at the time the application is submitted?
- With regard to plan benefits, if dental benefits are being provided as a direct service by the county (not an insurance product), could that be proposed as a deviation?
- Will Health-e-App screen children to Healthy Kids based on immigration status?
- Can the Healthy Kids program be split so that the First 5 Commission is administering the S-CHIP eligible program and have a separate entity administer the rest of the program?
- What if the County is anticipating setting a cap or establishing a waiting list?
- Does a separate administrative system have to be set up just for the C-CHIP program?
Answer: Each county has a different level of interest and different priority levels for what they would be willing to do. Variation in counties' readiness and strategic interests make a truly statewide approach difficult.
Answer: The County will need to describe how they will refer ineligible children to Medi-Cal or HFP at initial application and renewal.
Answer: No, not at this time. Health-e-App can only be used for initial applications.
Answer: Counties will need to describe details such as how often the renewal process will occur and whether the renewal package will be pre-printed.
Answer: A full list of the possibilities, including the full plan must be submitted.
Answer: Yes, but still subject to CMS approval.
Answer: No, not at this time. A child would be screened for Medi-Cal for emergency services only. This is an area MRMIB needs to review.
Answer: That could be proposed as an option, but the State is to be held harmless in terms of Federal auditing. If funds which have been matched are later disallowed, the sponsor at the county level is fiscally responsible.
Answer: A detailed explanation of how the cap or a waiting list is to be managed will have to be included in the application.
Answer: The Healthy Kids program does not have to set up separately for C-CHIP-eligible children. CMS understands that the application, for instance, is for the full Healthy Kids program, including non-S-CHIP eligible, but counties are only requesting matching funds for S-CHIP eligible kids.