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- Search | March 22, 1999      

         Dear TANF Administrators, State Medicaid Directors, and CHIP         Directors:      

         Through an ongoing strategy to reform welfare, the Administration has         fought to continue efforts to support low-income families, especially         those trying to make the transition from welfare to self-sufficiency.         As part of these efforts, it is critical that progress is made towards         increasing the number of Americans with health insurance. The         delinkage of Medicaid from cash assistance and declining welfare         caseloads have created both challenges and opportunities for providing         this support for working families. It is important that we use         effective strategies and find new ways to reach children and families         outside, as well as through, the welfare system.      

         In order to help policy-makers overcome these challenges, and to         realize the potential of these opportunities, we have developed the         enclosed guide, "Supporting Families in Transition: A Guide to         Expanding Health Coverage in the Post-Welfare Reform World." This         guide contains information regarding processes and procedures that         will help ensure as many children and families as possible obtain         health insurance.      

         In a letter we sent you on June 5, 1998         (http://www.hcfa.gov/medicaid/wrdl605.htm), we encouraged you to         coordinate both the administration of, and eligibility for, your TANF         and Medicaid programs. In that letter, we highlighted states’         responsibilities to establish and maintain Medicaid eligibility for         families and children affected by welfare reform, and we also outlined         the broad flexibility the statute affords you to expand eligibility.         Through the enclosed guide, we are providing additional information to         help you accomplish these important goals.      

         In addition to explaining state options and suggesting appropriate         strategies, the guide summarizes the application and enrollment         requirements for the Medicaid program. Two of the most critical         requirements are that States must:      

            · **Provide Medicaid applications upon request.** Based            on Medicaid regulations (42 CFR 435.906), the Department of Health            and Human Services (DHHS) has determined that states using joint            TANF-Medicaid applications must furnish a Medicaid application            immediately upon request and may not impose a waiting period before            providing the application for Medicaid.         

            · **Process Medicaid applications without delay.** States            must assure that an application for Medicaid is processed quickly            and not delayed by any TANF requirement. In states where TANF            application or eligibility is delayed (i.e., families receive            diversionary assistance or face any other initial administrative            steps), the state must process the joint application immediately to            determine Medicaid eligibility.         

         Page 2 – Dear Administrators and Directors      

         In addition to issuing the guide, we will be expanding our technical         assistance efforts to states to ensure that TANF programs are designed         and implemented so that children and their families are informed about         Medicaid and CHIP and enrolled when eligible. To focus our efforts         more effectively, we will work with states to review their welfare and         Medicaid eligibility and enrollment procedures. This process will help         us assist state agencies in improving their practices, it will further         help us by identifying successful models of coordination that can be         shared with other states.      

         We recognize the new needs for outreach, accessibility, and         coordination that have arisen from the delinkage of Medicaid from the         welfare system, and the growing number of working families unlikely to         enter the welfare office but likely to be eligible for Medicaid. In         light of these new challenges, we are committed to working with you to         establish the most effective Medicaid application and enrollment         procedures for low-income families with children.      

         We look forward to continuing this very important work with you and to         charting the gains we make together in improving the health coverage         of all low-income children and families, and in supporting the         transitions of families from welfare to self-sufficiency. In the         meantime, please contact your HCFA or ACF Regional Administrator or         your Regional Director with any questions or for additional         information.      

         Sincerely,      

         Olivia Golden                   Assistant Secretary                   Administration for Children and Families      

         Nancy Ann Min DeParle                  Administrator                  Health Care Financing Administration      
Last Modified on Friday, September 17, 2004   |
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         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