Continuity of care is ensured Yes Title V 0 None during periods of enrollment 1 Weak (IF YES) How effective are those State Medicaid and transition such as policies and procedures? CHIP 2 Moderate changes in or temporary 1 Not effective Health Plan/Insurer 3 Strong loss of insurance coverage 2 Somewhat effective Provider (please specify) (public and private). 3 Very effective Family/Consumer Other (please specify) OPTIONAL: Why? No for score, above ) (Select “0” Not applicable to my organization Enter Score: Enter Score: Written policies and Yes Title V 0 None procedures are in place for (IF YES) How effective are those State Medicaid 1 Weak transitioning CYSHCN policies and procedures? CHIP 2 Moderate between non-network and 1 Not effective Health Plan/Insurer 3 Strong network providers and 2 Somewhat effective Provider (please specify) communication with the 3 Very effective Family/Consumer medical home and family to Other (please specify) ensure continuity of care. OPTIONAL: Why? No for score, above ) (Select “0” Not applicable to my organization Enter Score: Enter Score:
Continuity of care is ensured during periods of enrollment and transition such as changes in or temporary loss of insurance coverage (public and private). 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: Written policies and procedures are in place for transitioning CYSHCN between non-network and network providers and communication with the medical home and family to ensure continuity of care. 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:
2_Eligibility%20and%20Enrollment_In%20DepthFINAL.docx