Get Model Application Template For State Child Health ... - Ncdhhs

The Model Application Template for the State Children’s Health Insurance Program offers a structured approach for states to apply for funding to support children’s health assistance programs. This guide provides step-by-step instructions on how to effectively complete the application online, ensuring all necessary information is accurately provided.

Follow the steps to fill out the form correctly.

1. Click the “Get Form” button to acquire the form and open it in your preferred editor.
2. Begin with the introductory section where you will enter the name of your state or territory at the designated field.
3. In the section regarding submission details, include the signature of the Governor or authorized designee along with the date signed.
4. Complete the section identifying the state officials overseeing the program. Provide the names and titles of the individuals responsible for program administration.
5. Fill out the assurance information about the financial expenditure, ensuring to claim only post-approval costs.
6. Detail the program objectives for child health coverage, marking the appropriate boxes related to coverage options and benefits.
7. Provide the dates for effective and implementation of each plan or amendment as required in the specified sections.
8. Describe the outreach efforts for informing families. This involves detailing strategies for encouraging enrollment among targeted low-income children.
9. Once all sections are filled out, review the complete application for accuracy and completeness.
10. Finally, save your changes, then download, print, or share the application form as necessary.

Complete the MODEL APPLICATION TEMPLATE online to initiate the process for your state's child health program.