New York State’s Child Health Plus (CHP) program has undergone dramatic expansion in the past few years and is of increasing importance to low-income families with income above Medicaid levels.  Our clients often struggle with medical bills incurred during gaps in CHP coverage. Understanding eligibility and enrollment processes for CHP, and how the program differs from Medicaid, can help advocates make arguments about the timing of enrollment or dis-enrollment and the obligations plans may have had to extend coverage.

Advocates looking for official guidelines from the New York State Department of Health (NYSDOH) on CHP can look to the Model Contract for the CHP program.   Another good source for an official explanation of health plan obligations and responsiblities is the CHP Plan Manual .  General rules regarding eligibility for CHP also exist in statute.  See N.Y. Public Health Law §2511.   However, SDOH does not issue administrative directives to govern administration of the CHP program in anywhere near the volume it does for Medicaid and Family Health Plus, because local districts play a much smaller role in running the program.  Instead, NYSDOH contracts with health plans to process applications and make eligibility decisions..  

As of October 14, 2009, the 2008-2012 CHP contract is the most recent available.  However, advocates should be aware that SDOH is in the process of revising the contract.  The updated contract will be posted here as soon as it is available.

This article was authored by the Empire Justice Center.