FRAMEWORK FOR THE ANNUAL REPORT OF THE CHILDREN’S HEALTH INSURANCE PLANS UNDER TITLE XXI OF THE SOCIAL SECURITY ACT - Annual report template framework

Oct 1, 2026

Framework describing the annual reporting requirements for state children’s health insurance plans under Title XXI of the Social Security Act. It specifies statutory timing and compliance conditions, explains how states must assess plan operations and progress in reducing the number of uncovered, low-income children, and outlines the CARTS structure. It also defines roles, submission guidance, and required content sections, including program snapshots, performance measurement, state plan assessment, financing, and program challenges and accomplishments.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages77

Reading Time3 h 14 min

AccessFree to download

Preamble

Statutory assessment and reporting deadlines

Purpose and design goals of the framework

CHIP Annual Report Template System (CARTS) Overview

Section I: Snapshot of CHIP Programs and Changes

Section II: Program’s Performance Measurement and Progress

Section III: Assessment of State Plan and Program Operation

Section IV: Program Financing for State Plan

Section V: Program Challenges and Accomplishments

Submission Guidance and Disclosure

OMB Paperwork Reduction Act disclosure and burden estimate

Certification instruction before submission

Reporting Header Information

State/Territory identification and submission period

Signature, contact person, and communication details

Section I: Snapshot of CHIP Program and Changes

At-a-glance information requests and assurance checkbox

Premiums and enrollment fee questions (CHIP Medicaid Expansion vs. Separate Child Health Program)

FRAMEWORK FOR THE ANNUAL REPORT OF THE CHILDREN’S HEALTH INSURANCE PLANS UNDER TITLE XXI OF THE SOCIAL SECURITY ACT Preamble Section 2108(a) and Section 2108(e) of the Social Security Act (the Act) provide that each state and territory􀀍 must assess the operation of its state child health plan in each federal fiscal year and report to the Secretary, by January 1 following the end of the federal fiscal year, on the results of the assessment. In addition, this section of the Act provides that the state must assess the progress made in reducing the number of uncovered, low-income children. The state is out of compliance with CHIP statute and regulations if the report is not submitted by January 1. The state is also out of compliance if any section of this report relevant to the state’s program is incomplete. The framework is designed to: • Recognize the diversity of state approaches to CHIP and allow states flexibility to highlight key accomplishments and progress of their CHIP programs, AND • Provide consistency across states in the structure, content, and format of thereport, AND • Build on data already collected by CMS quarterly enrollment and expenditure reports, AND • Enhance accessibility of information to stakeholders on the achievements under Title XXI The CHIP Annual Report Template System (CARTS) is organized as follows: • Section I: Snapshot of CHIP Programs and Changes • Section II: Program’s Performance Measurement and Progress • Section III: Assessment of State Plan and Program Operation • Section IV: Program Financing for State Plan • Section V: Program Challenges and Accomplishments * -When “state” is referenced throughout this template it is defined as either a state or a territory. *Disclosure. According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-1148. The time required to complete this information collection is estimated to average 40 hours per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, write to: CMS, 7500 Security Blvd., Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850. FRAMEWORK FOR THE ANNUAL REPORT OF THE CHILDREN’S HEALTH INSURANCE PLANS UNDER TITLE XXI OF THE SOCIAL SECURITY ACT DO NOT CERTIFY YOUR REPORT UNTIL ALL SECTIONS ARE COMPLETE. State/Territory: Ohio (Name of State/Territory) The following Annual Report is submitted in compliance with Title XXI of the Social Security Act (Section 2108(a) and Section 2108(e)) . Signature: Barbara Sears, State Medicaid Director CHIP Program Name(s): All, Ohio CHIP Program Type: CHIP Medicaid Expansion Only Separate Child Health Program Only Combination of the above Reporting Note: Federal Fiscal Year 2017 starts Period: 2017 10/1/2016 and ends 9/30/2017 . Contact Person/Title: Jang Won Seo, MHS Administrator 1 Address: 50 West Town Street, Suite 400 City: Columbus State: Ohio Zip: 43215 Phone: 614 – 752 – 2371 Fax: ( ) Email: [JangWon.Seo@medicaid.ohio.gov](JangWon.Seo@medicaid.ohio.gov) [Submission Date:](Submission Date:) (Due to your CMS Regional Contact and Central Office Project Officer by January 1st of each year) Section I: Snapshot of CHIP Program and Changes 1) To provide a summary at-a-glance of your CHIP program, please provide the following information. If you would like to make any comments on your responses, please explain in narrative below this table. [Check box] Provide an assurance that your state’s CHIP program eligibility criteria as set forth in the CHIP state plan in section 4, inclusive of PDF pages re

FAQs

What are the compliance and submission conditions for the CHIP annual report?

States must submit the report by January 1 following the end of the federal fiscal year. A state is also out of compliance if any section relevant to its program is incomplete.

What is the CARTS structure for the CHIP annual report?

CARTS is organized into five sections: (I) Snapshot of CHIP Programs and Changes, (II) Program’s Performance Measurement and Progress, (III) Assessment of State Plan and Program Operation, (IV) Program Financing for State Plan, and (V) Program Challenges and Accomplishments.

What additional disclosures and burden information are included?

The framework includes Paperwork Reduction Act disclosure stating no response is required without a valid OMB control number, provides the valid OMB control number (0938-1148), and estimates an average 40 hours per response.

Oct 1, 2026

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