States Public Health Service). NOTE: This number should not include CICP clients. Any other Third-Party Payer not mentioned above (such as private insurance) STEP 3 - Subtract all of the numbers identified in STEP 2 from the total identified in STEP 1 to compute the total number of uninsured patients served by the applicant agency STEP 4 - From the population identified in STEP 3, state the number of patients served by the applicant agency whose family incomes are above 200% of the Federal Poverty Level (200% FPL). STEP 5 - Subtract the total listed in STEP 4 from the total identified in STEP 3 to compute the total number of Medically Indigent Patients with incomes below 200% FPL. Note that this number will include CICP clients whose family income is below 200% FPL. Since the CICP provides discounted medical services to individuals up to 250% FPL (CICP rating H and I) the figure may not include all CICP patients served by the applicant agency Question 1 Table 2 UNDUPLICATED USER/PATIENT COUNT - PERCENTAGES Use the following formula to identify the percent of Unduplicated Users/Patients served by the applicant agency who are enrolled in Medicaid, enrolled in CHP+ or are Medically Indigent Patients. Freeze Date: in ITEM A - List the total number of Unduplicated Users/Patients served CHP+ by the applicant agency during the calendar year January 1, 2015– December 31, 2015 that were STEP Enrolled in Medicaid 2b (Report STEP 2a from Question 1 Table 1) from
States Public Health Service). NOTE: This number should not include CICP clients. Any other Third-Party Payer not mentioned above (such as private insurance) STEP 3 - Subtract all of the numbers identified in STEP 2 from the total identified in STEP 1 to compute the total number of uninsured patients served by the applicant agency STEP 4 - From the population identified in STEP 3, state the number of patients served by the applicant agency whose family incomes are above 200% of the Federal Poverty Level (200% FPL). STEP 5 - Subtract the total listed in STEP 4 from the total identified in STEP 3 to compute the total number of Medically Indigent Patients with incomes below 200% FPL. Note that this number will include CICP clients whose family income is below 200% FPL. Since the CICP provides discounted medical services to individuals up to 250% FPL (CICP rating H and I) the figure may not include all CICP patients served by the applicant agency Question 1 Table 2 UNDUPLICATED USER/PATIENT COUNT - PERCENTAGES Use the following formula to identify the percent of Unduplicated Users/Patients served by the applicant agency who are enrolled in Medicaid, enrolled in CHP+ or are Medically Indigent Patients. Freeze Date: ITEM A - List the total number of Unduplicated Users/Patients served by the applicant agency during the calendar year January 1, 2015– December 31, 2015 that were Enrolled in Medicaid (Report STEP 2a from Question 1 Table 1) in CHP+ STEP 2b from
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