04/05/04

Summary:

  • Introduces Illinois Healthy Women (IHW) which provides family planning services to certain women which is being implemented 04/19/04.
  1. Authorization of the Initial 3 Month Illinois Healthy Women Coverage
  2. Extension of Illinois Healthy Women Coverage
  3. Illinois Healthy Women Card
  4. Change Actions
  5. ACID
  6. Women Deleted or Canceled 01/10/04 - 04/18/04

This 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 other persons. This information is to be used by the Central KidCare Unit for authorizing medical benefits for these persons.

The Illinois Department of Public Aid will expand access to family planning services that enable women to choose the number and spacing of their pregnancies. This program, called Illinois Healthy Women (IHW), will begin April 19, 2004.

The policies and procedures in this memorandum are to be used by the Central KidCare Unit located in Springfield. DHS local office staff do not use these procedures, except to provide the toll free phone number (1-800-226-0768) to women with questions about Illinois Healthy Women. Noncitizens who inquire about family planning services may be referred to the Health and Human Services Helpline at 1-800-323-4769 (TTY 1-800-323-1476).

To be eligible for the Illinois Healthy Women Program, a woman must be at least age 19 and younger than age 45 and have lost medical benefits under one of the following circumstances:

  • her eligibility status changed to spenddown;
  • she was deleted from an active Category 04, 06, 94, or 96 case with any Type Action Reason (TAR) except for 01, 02, 06, 09, 10, 14, 20, 43, or 44;
  • she was receiving medical benefits in a Category 04 or 06 case and was canceled with any TAR except for 00, 08, 14, 16, 21, 28, 47, 49, 50, 56, 57, 58, 63, 64, 77, 78, 83, 84, 94, 95, or 96;
  • she was receiving medical benefits in a Category 94 or 96 case and was with any TAR except 00, 06, 15, 16, 28, 40, 49, 50, 56, 77, 78, 94, or 95;
  • she was receiving medical benefits in a Category 02, 03, 92, or 93 case and was with any TAR except 00, 28, 49, 50, 56, 77, 78, 94, 95, or 96;
  • she was receiving benefits in a Category 07 and was with a TA 22 or TA 28 with a TAR 76; or
  • she was receiving benefits in a Category 07 case and was deleted with a TA 34 or TA 36 with a TAR 05.

Eligible women will receive a pink identification card called the Illinois Healthy Women Card (Form 469HW). The initial card is valid for 3 months. The coverage will show on MMIS under Special Program Eligibility with a MANG(P) code of FP. However, women who will reach age 45 within the 3 month period are not eligible and will not receive the initial 3 month card.

To receive benefits after the initial 3 months, the woman must sign and return the centrally issued Illinois Healthy Women Enrollment Form (Form 3815) indicating her desire to continue under the program. If she does this, Form 469HW will be issued for an additional 9 months of coverage under the program or until the last day of the month in which she reaches age 45.

After the first 12 months of coverage, an annual re-enrollment will be required. An Illinois Healthy Women Re-Enrollment Form (Form 3815A) will be centrally generated and mailed to a woman eligible for re-enrollment at least 2 months prior to the end of her 12 month eligibility period. A woman who wishes to re-enroll must use the Illinois Healthy Women Family Income Worksheet (Form 3815B) to calculate her countable income. If it is no greater than 200% of poverty, she must declare that fact on the Form 3815A, sign it, and return it to the Department by the required date. Form 3815B is not returned with the Form 3815A.

Upon receipt of Form 3815A, the Central KidCare Unit will process the re-enrollment and for eligible women will issue a new pink card for an additional 12 months of coverage. A woman who will reach age 45 within a year will be enrolled until the last day of the month of her birth.

The Illinois Healthy Women Card will cover the following services:

  • Physical exam and health history for family planning purposes.
  • Office visits related to family planning.
  • Pap smears, at least annually, or as medically indicated.
  • Necessary family planning or women's health related lab and diagnostic tests.
  • Birth control drugs and devices including the inserting, implanting, or injecting of a birth control drug, and removing a birth control device.
  • Sterilization services.
  • Testing for sexually transmitted infections, including HIV, diagnosed during a family planning visit.
  • Treatment for sexually transmitted infections (except HIV) diagnosed during a family planning visit.
  • Mammograms as medically indicated.
  • Generic prenatal vitamins or generic multivitamins with folic acid.

Noncitizens with a code 36 or code 50 in Item 74 are not eligible for Illinois Healthy Women. They may be referred to the Health and Human Services Helpline at 1-800-323-4769 (TTY 1-800-323-1476).

Authorization of the Initial 3 Month Illinois Healthy Women Coverage

Women cannot apply for the IHW program. When a woman is deleted from other medical benefits, the central computer system will determine eligibility for IHW. If eligible, the computer system centrally:

  • Approves a new Category 94 IHW case for women who meet the criteria using TA 10 new TAR C2 unless there is already an IHW case active. The IHW case will have the same coding as the case where the woman was previously receiving benefits except:
    • Local office will be 190 with a new case ID number. - Item 78 will contain a dash. - Item 80 countable income codes are deleted. A countable income code is not required for IHW cases.
  • Authorizes 3 months of coverage beginning:
    • the first day of the calendar month following the last day or regular eligibility for Category 03, 93, 94, and 96 cases.
    • the first day of the calendar month in which eligibility ended for Category 04 and 06 cases.
  • Generates Form 469HW for a 3 month period for the woman. The Illinois Healthy Women brochure (Form 3814) will be sent with each card.
  • Sends the woman Illinois Healthy Women Fact Sheet (Form 3711HW), Illinois Healthy Women Enrollment Form (Form 3815), and a self-addressed, postage paid envelope in a separate mailing at the same time Form 469HW is mailed.
  • Sends information to MMIS to set up a special eligibility segment with Item 60 MANG(P) Code "FP."
  • Generates a TA 28/TAR C2.

Extension of Illinois Healthy Women Coverage

When a woman returns a completed Form 3815 by the required date to the Central KidCare Unit, she is eligible for 9 more months of IHW benefits.

The Central KidCare Unit:

  • Processes a TA 10/TAR C3 via IPACS or ACM to reinstate the IHW case.
  • Enters the case name, case address, and case number.

The computer system:

  • Enters in Item 77, the first day of the calendar month in Item 31 from the TA 10/TAR C2 action.
  • Enters in Item 32, 11 months from the opening date in Item 77. For example, if Item 77 date is 07/01/04, the Item 32 date is 06/05.
  • Enters new Item 80 Code 379 FPW. In the AMOUNT field, enters 01. Updates this code each time a TA 10/TAR C3/C4 is processed. In the PERSONS field, enters a Y.
  • Generates an Illinois Healthy Women Card for the entire 12 month period.
  • Processes a TA 28/TAR C3 to cancel the case.
  • Updates the special eligibility segment in MMIS with Item 60 MANG(P) Code "FP."
  • Sends Illinois Healthy Women Re-Enrollment Form (Form 3815A) and Form 3815B at schedule cut-off for the 10th month of eligibility if the woman is not receiving medical benefits on a regular case.

If a woman returns a completed Form 3815A to the Central KidCare Unit, she is eligible for 12 more months of IHW benefits if she indicates that she meets the income requirements.

The Central KidCare Unit processes a TA 10/TAR C4 via IPACS or ACM to reinstate the IHW case.

The computer system:

  • Enters in Item 77, the first day of the month in Item 32 from previous action.
  • Enters in Item 32, 11 months from the opening date in Item 77.
  • Updates the number in the AMOUNT field in the Item 80 Code 379 FPW each time a TA 10/TAR C4 is processed.
  • In the PERSONS field, enters a Y.Generates an Illinois Healthy Women Card for a 12 month period for the woman.
  • Updates the special eligibility segment in MMIS with Item 60 MANG(P) Code "FP" for payment of family planning services only.
  • Generates a TA 28/TAR C4.

Illinois Healthy Women Card

The format of the Illinois Healthy Women Card is similar to the MediPlan Card. The IHW card is pink and it contains the following restriction message:

Coverage limited to family planning exams, birth control, pap smears, Mammograms, labs, and diagnostic tests related to family planning and treatment of STD's (except HIV) found at a family planning visit. There are no copays for family planning services. Certain other prescription drugs may be subject to copays.

An Illinois Healthy Women Card can be replaced with a TA 55 action.

Change Actions

The only change actions allowed on an IHW case are:

  • TA 39/TAR 41 to change the address; and
  • TA 39/TAR 40 to change the case name, the birth date, and the PERSONS field with Code 379 FPW. The PERSON field can contain:
    • Y to send the next 3815A.
    • N to suppress the next Form 3815A.
    • S to suppress the next Form 3815A if it is learned that the woman has been sterilized. This will also prevent her from being invited to enroll in the future.

ACID

IHW participants are identified on screen one of ACID in the Case Status field as "Family Planning Only." "Y" tags will not be displayed in the history field for an IHW case.

Women Deleted or Canceled 01/10/04 - 04/18/04

Women who were deleted from medical benefits between 01/10/04 - 04/18/04 and who meet the eligibility criteria for IHW will be centrally enrolled in the IHW program. For these cases, the beginning eligibility date is 06/01/04. Continued enrollment and re-enrollment will occur as for other cases described above.

[signed copy on file]

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

BARRY S. MARAM
Director, Illinois Department of Public Aid

Forms referenced:
Form 469HW
Form 3711HW
Form 3814
Form 3815
Form 3815A
Form 3815B