FORM H1830-L
Instructions

Children's health-care benefits renewal notice

09/2013

PURPOSE

  • To explain to clients their responsibilities for completing and submitting the renewal form for Children's health-care benefits programs.
  • To tell clients what to send back with the renewal form.

PROCEDURE

When to Prepare

Send Form H1830-L with the redetermination packet for:

  • Children's Medicaid the first of the fourth month in a six-month continuous eligibility period or the 10th month of the 12-month certification;
  • Children's Health Insurance Program (CHIP) the first week of the 10th month of the 12-month certification; or
  • CHIP perinatal the first week of the 10th month of the 12-month certification.

Number of Copies

Complete an original and two copies.

Transmittal

Mail the original to Clients with Form H1014-R, Children's health insurance renewal application. Include a return, stamped envelope.

File one copy under miscellaneous in the case folder. The third copy can be used for monitoring and tracking.

Form Retention

Keep the copy until the next renewal for Children's health-care benefits.

DETAILED INSTRUCTIONS

Enter the Client's name and address. Also enter the case number at the top of the form. Enter the name of the advisor, local office address, and telephone number. The remainder of the form is self-explanatory.