(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 150% of the 2003 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) during the three months prior to applying for CHIP. This three month waiting 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) Income information for all family members must be included on the signed and dated application.

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

(b) 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 three month 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 re-qualifies 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.

(a) Applicants will be mailed a form to authorize the use and disclosure of health information that will include questions about the family's health insurance and whether health insurance is available to the family.

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

(7) CHIP benefits do not start until the applicant is enrolled with the insurer 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 nor enrollment with an insurer.

(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.