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[Medicaid] GenIC #17 (Revised): CHIP State Plan Eligibility CMCS
 
New
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CS3 Yes Yes Fillable Fileable
Form CS7 Yes Yes Fillable Fileable
Form CS8 Yes Yes Fillable Fileable
Form CS9 Yes Yes Fillable Fileable
Form CS10 Yes Yes Fillable Fileable
Form CS11 Yes Yes Fillable Fileable
Form CS12 Yes Yes Fillable Fileable
Form CS13 Yes Yes Fillable Fileable
Form CS14 Yes Yes Fillable Fileable
Form CS15 Yes Yes Fillable Fileable
Form CS16 Yes Yes Fillable Fileable
Form CS17 Yes Yes Fillable Fileable
Form CS18 Yes Yes Fillable Fileable
Form CS19 Yes Yes Fillable Fileable
Form CS20 Yes Yes Fillable Fileable
Form CS21 Yes Yes Fillable Fileable
Form CS23 Yes Yes Fillable Fileable
Form CS24 Yes Yes Fillable Fileable
Form CS27 Yes Yes Fillable Fileable
Form CS28 Yes Yes Fillable Fileable
Form CS29 Yes Yes Fillable Fileable
Form CS31 Yes Yes Fillable Fileable
Other-Introduction to the IG Yes No Printable Only
Other-IG (CS3) Eligibility for Medicaid Expansion Program Yes No Printable Only
Other-IG (CS7) Eligibility - Targeted Low-Income Children Yes No Printable Only
Other-IG (CS8) Eligibility - Targeted Low-Income Pregnant Women Yes No Printable Only
Other-IG (CS9) Eligibility - Coverage From Conception to Birth Yes No Printable Only
Other-IG (CS10) Eligibility - Children Who Have Access to Public Employee Coverage Yes No Printable Only
Other-IG (CS11) Eligibility - Pregnant Women Who Have Access to Public Employee Coverage Yes No Fillable Fileable
Other-IG (CS12) Eligibility - Dental Only Supplemental Coverage Yes No Printable Only
Other-IG (CS13) Eligibility - Deemed Newborns Yes No Printable Only
Other-IG (CS14) Eligibility - Children Ineligible for Medicaid as a Result of the Elimination of Income Disregards Yes No Printable Only
Other-IG (CS15) MAGI-Based Income Methodologies Yes No Printable Only
Other-IG (CS16) Other Eligibility Criteria – Spenddowns Yes No Printable Only
Other-IG (CS17) Non-Financial Eligibility – Residency Yes No Fillable Printable
Other-IG (CS18) Non-Financial Eligibility – Citizenship Yes No Printable Only
Other-IG (CS19) Non-Financial Eligibility - Social Security Number Yes No Printable Only
Other-IG (CS20) Non-Financial Eligibility - Substitution of Coverage Yes No Printable Only
Other-IG (CS21) Non-Financial Eligibility - Non-Payment of Premiums Yes Yes Printable Only
Other-IG (CS23) Non-Financial Requirements - Other Eligibility Standards Yes No Printable Only
Other-IG (CS24) General Eligibility - Eligibility Processing Yes No Printable Only
Other-IG (CS27) General Eligibility – Continuous Eligibility Yes No Fillable Fileable
Other-IG (CS28) General Eligibility - Presumptive Eligibility for Children Yes No Printable Only
Other-IG (CS29) General Eligibility - Presumptive Eligibility for Pregnant Women Yes No Printable Only
Other-IG (CS31) General Eligibility – Incarcerated CHIP Beneficiaries Yes No Printable Only

Health Health Care Services

 

56 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 56 0 56 0 0 0
Annual IC Time Burden (Hours) 5 0 5 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Generic Supporting Statement 07/09/2025
REDLINE - Introduction to the Implementation Guides (IGs) 07/09/2025
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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