Delaware Healthy Children Program - Frequently Asked Questions
Q. What is the Delaware Healthy Children Program?
A. Low cost health insurance for children who are currently uninsured. It gives your children all the benefits most private plans do.
Q. How do I know if my children are eligible?
A. Uninsured children from birth to the age of 19 who live in families with incomes below the 200% Federal Poverty Level .
Q. How do I apply?
A. You can apply by calling our Delaware Healthy Children Program's 1-800 # . The Health Benefit Manager will assist you with the application.
Q. What if my child already has some health coverage?
A. A child who has comprehensive health insurance is not eligible for the Delaware Healthy Children Program. Comprehensive Health Insurance means full benefits-it must cover the following four things to be considered comprehensive: hospitalization, doctor visits, x-rays and lab work. A child with limited coverage may still be eligible for Delaware Healthy Children Program.
*Exception: Children with coverage in a comprehensive health plan are eligible for Delaware Medicaid if they meet income requirements.
Q. What if I have insurance for my child but it is too expensive?
A. A child who already has health insurance, even if it is very expensive, is not eligible for the Delaware Healthy Children Program. If a child is voluntarily dropped from health insurance due to the cost of coverage, they are not eligible for the Delaware Healthy Children Program for six months from the drop date.
Q. What is qualified non-citizen?
A. In general, children eligible for the Delaware Healthy Children Program must be U.S. citizens. However, the federal government classifies some non-citizen children as “qualified aliens”. These children are eligible. Also remember some children born outside of the U.S. may be citizens.
Examples of Non-Citizen Children Who May Be Eligible:
- Lawful permanent residents who entered the U.S. before August 22, 1996
- Parolees of more than one year and conditional entrants
- Refugees, asylees, and those whose removal has been withheld
- Cuban and Haitian entrants
- Amerasians
- Dependents of veterans and active-duty military
Many other groups of non-citizen children may be eligible. Call our Delaware Healthy Children Program's 1-800 # to ask.
Q. Are children of State Employees eligible?
A. Children of Permanent State of Delaware employees are not eligible for the Delaware Healthy Children Program. However, children of seasonal, casual or temporary state employees can get the Delaware Healthy Children Program if they meet the income guidelines. Children of Permanent State of Delaware employees may be eligible to receive Delaware Medicaid.
Q. Why aren't children of state employees eligible
A. Delaware Healthy Children Program uses federal funds from Title XXI, the Children Health Insurance Program. By federal law, these funds cannot be used for dependents of state employees.
Q. What about pre-existing conditions or medical eligibility?
A. The Delaware Healthy Children Program does not exclude children because of pre-existing health conditions.
Delaware Medicaid does have a Disabled Child Medicaid Program which covers children with special conditions and it does require clinical eligibility.
If you think a child has a medical, behavioral or developmental condition that requires extra attention, you can request the application by calling the DSS Main Office and asking for the Disabled Child Medicaid Program.
Q. How is Delaware Healthy Children Program different from other Delaware Medicaid programs?
A. Medicaid eligibility depends on the child's age along with the household income and household size. Delaware Healthy Children Program checks all applications for Medicaid eligibility. If a child qualifies, by federal law he or she enrolls in Delaware Medicaid, not the paid premium program. No interview is needed. No visit to a State Service Center is required when a Delaware Medicaid annual redetermination review is due.
Q. How often does Delaware Healthy Children review eligibility? What is the process?
A. All children in Delaware Healthy Children Program have at least 12 months of continuous coverage if monthly premiums are paid. Prior to the end of their eligibility coverage, families will receive an application in the mail and will be required to submit a copy of one month of income verification along with a completed application.
Q. How much do I have to pay?
A. $10, $15 or $25 per household per month, depending on your income.
There is an added bonus-for every three months you pay in advance, you'll get the 4th month free! And, with the exception of non-emergency visits to hospital emergency rooms, there are no co-payments. Prescriptions are covered at 100%.
Q. Who provides the insurance?
A. You have a choice of two managed care plans: Coventry/Delaware Care and First State Health Plan. The program is administered by the Division of Social Services.
Q. Are parents covered too?
A. Sorry. The plan is currently limited to children under the age of 19. But a single monthly fee does cover every child in the household eligible for the plan. Some families, depending on household size and income, may have children eligible for both Delaware Medicaid and the Delaware Healthy Children Program.
Q. When will my coverage start?
A. After you are approved for the program, you must choose a managed care plan and pay the first month's premium. You will receive a notice telling you when your coverage begins.
