(1) An applicant may be eligible for covered services under CHIP if:

(a) the applicant is under 19 years of age;

(b) the applicant's social security number is provided. Benefits will not be denied or delayed to an otherwise eligible applicant pending issuance of his or her social security number;

(c) the family of which the applicant is a member has annual family income, without regard to other family resources, at or below 175% of the federal poverty level (FPL);

(d) the applicant is a Montana resident;

(e) the applicant is a U.S. citizen or qualified alien as defined under federal statute;

(f) the applicant is not incarcerated;

(g) the applicant is not an inpatient in an institution for mental disease on the date of application or reapplication;

(h) the applicant does not have or has not had creditable health insurance coverage as defined in 42 USC 300gg(c) 30 days prior to becoming eligible for CHIP. This 30 day period shall not apply if the parent or guardian providing the insurance:

(i) dies;

(ii) is fired or laid off;

(iii) can no longer work due to a disability;

(iv) has a lapse in insurance coverage due to new employment; or

(v) has an employer who does not offer dependent coverage.

(i) the applicant or the applicant's parent is not eligible for health insurance coverage under the state of Montana Employee's Health Insurance Plan; and

(j) the applicant is not eligible or potentially eligible for Medicaid coverage as determined by the department.

(2) Family income information for all family members must be included on the signed and dated application.

(a) Family income includes:

(i) the income of both parents if the child resides with both parents;

(ii) the income of the custodial parent, including any child support received for the child, if the child resides with one parent in a single parent household:

(A) If the custodial parent has remarried, the stepparent's income is imputed to the custodial parent.

(B) The income of individuals under the age of 19 who live in the household but do not attend school is imputed to the custodial parent.

(b) Family income does not include:

(i) money received from assets drawn down such as withdrawals from a savings account, an annuity, or from the sale of a house or a car;

(ii) gifts, loans, one-time insurance payments, or compensation for an injury;

(iii) the first $2,000 of an enrolled tribal member's per capita payment;

(iv) the first $2,000 of an enrolled tribal member's tribal land income;

(v) the interest earned on (2)(b)(iv) and (v);

(vi) earned income which is excluded and dependent care expenses which are deducted from income under the state Medicaid poverty programs for children;

(vii) income excluded under federal Medicaid regulations;

(viii) foster care income for any children unless the only children in the family are in foster care; or

(ix) income of an individual with whom a child resides who has no legal obligation to support the child.

(c) Income information will be used by the department to project the family's income.

(d) The family's debts, medical expenses, or other financial circumstances will not be taken into consideration when determining family income.

(3) An applicant whose CHIP enrollment ended because his or her parent was activated into military service and who was insured through Tri-care, which is the insurance available to active duty and retired military families during the parent's military activation period, is not subject to the 30 day waiting period for previous creditable health insurance and will be enrolled in CHIP if he or she continues to be eligible for CHIP. Upon notification that the parent was deactivated and the applicant loses Tri-care coverage, the applicant may be re-enrolled:

(a) the month after CHIP is notified, if the family has an open family span; or

(b) the month after a completed application is received and the applicant requalifies for CHIP benefits, if the family does not have an open family span.

(4) Applicants eligible to receive services from the Indian Health Services (IHS) program administered by the United States Department of Health and Human Services are eligible for CHIP if they meet the criteria specified in this subchapter.

(5) Applicants who are losing Medicaid coverage or who were denied Medicaid for a reason other than the family withdrew their application or failed to comply with Medicaid requirements will be referred to CHIP via an electronic report. CHIP eligibility will be determined and applicants will be enrolled in CHIP or placed on the CHIP waiting list.

(6) Applicants and their parents or guardians must comply with the procedures specified by the department as necessary to obtain or access benefits.

(7) CHIP benefits do not start until the applicant is enrolled even though the applicant may have been determined eligible for CHIP prior to the date of enrollment.

(8) CHIP eligibility is redetermined within one year after the initial eligibility period, and annually thereafter. A renewal application must be completed, signed, dated and returned by a specified date for purposes of eligibility redetermination. Prior eligibility for CHIP does not guarantee continued eligibility or enrollment in CHIP.

(9) CHIP eligibility and benefits are not an entitlement. If funding is insufficient, the department may reduce enrollment numbers or reduce eligibility to a lower percentage of the federal poverty level to limit the number of individuals who are eligible to participate.

(10) A determination of CHIP eligibility will be completed within 20 working days after receipt of a complete application.