Continuation of Benefits Upon Admission to a Department of Human Services Psychiatric Hospital

Helping Families. Supporting Communities. Empowering Individuals.

07/08/04

Summary:

  • Provides AABD eligibility for persons age 21 to 64 years of age who enter a DHS psychiatric hospital.
  • A DHS psychiatric hospital does not include a private community hospital that has contracted with DHS to provide services.
  • Policy is not changed concerning "living with" for a member of a TANF or FHP case.

This Policy Memorandum was prepared by the Illinois Department of Public Aid. DPA administers the Medicaid and KidCare programs. These programs provide medical benefits to families with children and to other persons. This information is to be used by staff of the Illinois Department of Human Services when authorizing medical benefits for persons on behalf of DPA.

Current AABD policy results in a gap or delay in coverage for persons age 21 through 64 years of age who are admitted to a DHS psychiatric hospital. Such a gap or delay in coverage may disrupt the person's treatment plan. Because these psychiatric hospital stays usually last less than 3 months, policy is changed to assure benefits continue without a gap.

Effective July 1, 2004, do not terminate AABD eligibility or deny an application if a person age 21 through 64 years of age enters a DHS psychiatric hospital.

Providing AABD eligibility during the DHS psychiatric hospital stay ensures that a gap or delay in coverage upon discharge will not occur. Medical coverage will remain active during the stay and be available immediately upon discharge. Upon discharge from the DHS psychiatric hospital, these persons are not required to reapply for medical benefits.

If the person is receiving AABD Cash at the time of admission to the DHS psychiatric hospital, continue benefits at the current level for up to 6 months if:

  • the person does not have a spouse and/or child(ren) in the home; and
  • AABD Cash is needed to maintain a home in the community; and
  • a doctor has certified the person is expected to return home within 6 months.

A proxy may be requested by the client. Refer to PM 22-01-01.

If the person remains in the DHS psychiatric hospital for more than 6 months or the person is not eligible for AABD Cash, SWAP the case to AABD Medical.

Treat AABD applicants and recipients age 21 through 64 years of age who enter a DHS psychiatric hospital as living in the community. Do not enter code "12" in Item 20. Do not enter a date in Item 42, Date Entered State Institution. Do not change the person's address to the DHS psychiatric hospital. The medical card will be mailed to the person's permanent address and not the address of the DHS psychiatric hospital. If the person receives AABD Cash, the delivery of benefits will not be changed.

Persons admitted for a psychiatric hospitalization to a private community hospital that has contracted with DHS are treated as receiving services in a community hospital and not a DHS psychiatric hospital.

Policy is not changed concerning "living with" for a member of a TANF or FHP case. A member admitted to a DHS psychiatric hospital can remain in the case for up to 3 months. Refer to PM 03-05-03.

A person in a DHS psychiatric hospital is considered a resident of an institution for food stamps. Refer to PM 04-05-04.

[signed copy on file]

CAROL L. ADAMS, Ph.D.
Secretary, Illinois Department of Human Services

BARRY S. MARAM
Director, Illinois Department of Public Aid