Written and oral information Yes Title V 0 None that is provided for purposes 1 Weak (IF YES) How effective are those State Medicaid of determining insurance policies and procedures? CHIP 2 Moderate eligibility and enrolling a 1 Not effective Health Plan/Insurer 3 Strong child into public or private 2 Somewhat effective Provider (please specify) insurance coverage is 3 Very effective Family/Consumer culturally appropriate and Other (please specify) provided in a manner and format appropriate for a OPTIONAL: child or their caregiver, Why? including for those families No for score, above) (Select “0” who have limited English Not applicable to my organization proficiency or sensory impairments. Enter Score: Enter Score: Effectiveness Indicator: Organizational Influence Indicator: SUMMARY: ELLIGEBILITY AND ENROLLMENT Additional Notes: ENDNOTES:
Written and oral information that is provided for purposes of determining insurance eligibility and enrolling a child into public or private insurance coverage is culturally appropriate and provided in a manner and format appropriate for a child or their caregiver, including for those families who have limited English proficiency or sensory impairments. Yes (IF YES) How effective are those policies and procedures? 1 Not effective 2 Somewhat effective 3 Very effective No (Select “0” for score, above) Not applicable to my organization Enter Score: Title V State Medicaid CHIP Health Plan/Insurer Provider (please specify) Family/Consumer Other (please specify) 0 None 1 Weak 2 Moderate 3 Strong OPTIONAL: Why? Enter Score: SUMMARY: ELLIGEBILITY AND ENROLLMENT Effectiveness Indicator: Organizational Influence Indicator: Additional Notes: ENDNOTES:
2_Eligibility%20and%20Enrollment_In%20DepthFINAL.docx