(1) With the exception noted in (6) , a child or youth, to be eligible for CSHS benefits, must be:

(a) a child or youth with either a disabling physical condition that can be substantially improved or corrected with surgery, or a condition or disease that can be cured, improved, or stabilized with medical treatment, or a child or youth suspected of having a disabling physical condition or a medical condition or disease;

(b) under 19 years of age or under 22 years of age if the child or youth has a disability for which a final cleft surgery or dental work is necessary;

(c) a resident of the state of Montana and either a U.S. citizen or a qualified alien as defined under federal statute;

(d) a member of a family whose income, less any out-of-pocket expenses for health insurance, is at or less than 200% of the federal poverty income guidelines; and

(e) one of the following:

(i) ineligible for medicaid;

(ii) eligible for medicaid, but in need of services or benefits that are not covered by medicaid but are covered by CSHS; or

(iii) potentially eligible for medicaid from information provided on the application, the family will be referred to the county office of public assistance for medicaid eligibility determination.

(2) Eligibility for program benefits will be determined within 30 days of receipt of the application by the department.

(3) Eligibility continues for 12 months from the date an application is received unless the child's or youth's age precludes them from participation or the child or youth moves from Montana.

(4) A new or renewal application for a subsequent year must be submitted to the department in order for the department to determine if eligibility is to continue and must be completed and approved before any CSHS benefits in a subsequent year may be provided.

(5) CSHS financial eligibility will be determined in accordance with the financial eligibility guidelines contained in CHIP's ARM 37.79.201, with the following exceptions:

(a) children who are eligible to receive state employee health coverage may be eligible for CSHS benefits;

(b) children may have health insurance coverage and the out-of-pocket expenses for health insurance are deducted from household income; and

(c) CSHS financial eligibility is at or below 200% of the federal poverty income guidelines.

(6) The above financial eligibility limits do not apply to a child or youth who has or is suspected of having a condition covered by CSHS and wishes to attend a clinic specifically for that condition.