GIS 11 MA/003: Transmittal Form from Local Departments of Social Services to Child Health Plus
To: Local District Commissioners, Medicaid Directors
From: Judith Arnold, Director - Division of Health Reform and Health Insurance Exchange Integration
Subject: Transmittal Form from Local Departments of Social Services to Child Health Plus
Attachments: Transmittal Form
Effective Date: Immediately
Contact Person: Local District Support Unit - Upstate (518) 474-8887, New York City (212) 417-4500
The purpose of this General Information System (GIS) message is to introduce local departments of social services (LDSS) to the transmittal form to be completed when forwarding applications to Child Health Plus (CHPlus).
Effective with the release of this GIS, the attached transmittal form must be used by an LDSS when processing applications for children who are denied Medicaid coverage due to excess income and/or immigrations status, and who are potentially eligible for CHPlus. The transmittal form should be used in conjunction with the instructions provided to LDSS in GIS 10 MA/015, "Processing Medicaid Applications for Children Potentially Eligible for Child Health Plus."
Reminder: Districts must use the rate for the region in which the facility is located.
