Issues in Developing Programs for Uninsured Children: A Resource Book for States. A. Referral to Medicaid When Applying to the Children's Health Insurance Program


Four of the nine states reported the establishment of a systematic referral for children eligible for Medicaid to the Medicaid program by separate children's health insurance programs.

  • In Colorado, families are referred to the county social services office for Medicaid enrollment. If they are applying to the CCHP program by mail, they receive a letter explaining why they are ineligible for the CCHP, notified of their potential eligibility for Medicaid, and referred to Medicaid.
  • In Massachusetts, applications for the state program are screened for Medicaid eligibility and eligibles are then sent Medicaid applications.
  • In New York, the State Department of Social Services (DSS) coordinates with Child Health Plus to refer children between Medicaid and other children's programs. County DSS offices also refer children and families to Child Health Plus and provide guidance to families regarding Medicaid and Child Health Plus eligibility. In addition, DSS explains procedures for terminating Child Health Plus when Medicaid eligibility is established.
  • In Pennsylvania, the five CHIP health plans are required to refer ineligible families to other sources of health care for which they may be eligible. Generally, families are referred to Medicaid programs. Last year over 8,000 referrals were made to the Pennsylvania Medicaid program.