Title 16
18000 Delaware Healthy Children Program
The following requirements are factors of eligibility specific to DHCP.
18200.1 Age Requirement
The individual must be under the age of 19. The rules on emancipated minors at DSSM 16220.2.3 will also apply to DHCP.
18200.2 Uninsured Requirement
The DHCP is limited to uninsured, low-income children. The following children are not eligible for DHCP:
a. Children who are eligible for Medicaid.
b. Children who have Medicare
c. Children who, at the time of application, have insurance coverage that meets the definition of comprehensive health insurance.
d. Children who have had comprehensive health insurance (other than Medicaid) within the six months preceding the month of application unless good cause exists for the loss of health insurance. The month of application is the month in which a signed application is received by DSS.
e. Children who are eligible for or who have access to coverage under a state health benefits plan on the basis of a family member’s employment with a public agency in the state.
f. Children who have Military Health Insurance for Active Duty, Retired Military, and their dependents
18200.2.1 Definition of Comprehensive Health Insurance
A benefit package comparable in scope to the "basic" benefit package required by the State of Delaware's Small Employer Health Insurance Act at Title 18, Chapter 72 of the Delaware Code. This package covers hospital and physician services as well as laboratory and radiology services. The term "comprehensive" does not mean coverage for benefits normally referred to as "optional," e.g., prescription drugs.
18200.2.2 Good Cause for Loss of Health Insurance
Good cause for loss of health insurance in the six months preceding the month of application are:
• death of parent
• disability of parent
• termination of employment
• change to a new employer who does not cover dependents
• change of address so that employer-sponsored coverage is not available – the provider service network is not available within the county in which the family resides
• expiration of the coverage periods established by COBRA
• employer terminating health coverage as a benefit for all employees
18200.3 Children of Public Agency Employees
A child who has a family member who works for a public agency within Delaware and is eligible to participate in the State health benefits plan with an employer premium subsidy is not eligible for DHCP. Family member is defined as the parent of the child or the individual who has legal custody of the child. The State health benefits plan is the plan that is offered or organized by the Sate of Delaware on behalf of State employees or other public agency employees within the state. The State health benefits plan does not include separately run county plans, city plans, or other municipal plans.
The following public agencies participate in the State health benefits plans and offer an employer subsidy:
All school districts, colleges, and universities
All charter schools
Delaware Solid Waste Authority
Delaware State Housing Authority
Delaware Stadium Corporation
Delaware Transit Authority
Council 81
Delaware Volunteer Fire Companies
Members of Boards & Commissions covered prior to 1/1/93
Diamond State Port Corporation
Commission on Continuing Legal Education
Delaware Council for Vocational Education
Office of Disciplinary Council
Law Library personnel in all counties
Riverfront Development Corporation
Delaware Criminal Justice Council
Governor's Advisory Council for Exceptional Citizens
18200.4 Residents of Institutions
A child who is a patient in an institution for mental disease (IMD) or who is an inmate of a public institution is not eligible.
18200.4.1 Patient in an Institution for Mental Disease
An Institution for Mental Disease (IMD) is a hospital, nursing facility, or other institution of more than 16 beds that is primarily engaged in providing diagnosis, treatment or care of persons with mental diseases, not including mental retardation.
A child who is an inpatient in an IMD at the time of application, or during the scheduled redetermination, is not eligible for DHCP. If a child enrolled in DHCP subsequently requires inpatient services in an IMD, the receipt of inpatient services will not make the child ineligible during a period of continuous eligibility.
The following in-state facilities are Institutions for Mental Diseases (IMD):
Charter BHS of Delaware at Rockford Center
Meadow Wood Behavioral Health System
18200.4.2 Inmate of a Public Institution
An inmate of a public institution is a person who is living in a public institution. A public institution is an institution that is the responsibility of a governmental unit or over which a governmental unit exercises administrative control. This control can exist when a facility is actually an organizational part of a governmental unit or when a governmental unit exercises final administrative control, including ownership and control of the physical facilities and grounds used to house inmates. Administrative control can also exist when a governmental unit is responsible for the ongoing daily activities of a facility; for example, when facility staff members are government employees or when a governmental unit, board, or officer has final authority to hire and fire employees. Privately supported institutions that are not under the control of a governmental unit do not meet the definition of a public institution.
A child is an inmate when serving time for a criminal offense or confined involuntarily in State or Federal prisons, jail, detention facilities, or other penal facilities. A child awaiting trial in a detention center is considered an inmate of a public institution. A child living in a detention center after his or her case has been adjudicated and other living arrangements are being made (such as a transfer to a community residence) is not an inmate of a public institution. Children who are sent to a privately supported institution as an alternative to a detention or prison sentence are not inmates of a public institution.
