Form 552 Coding Charts for Family Health Plans

ITEM 78 CODES FOR PERSONS AGE 19 & OVER IN A 94 OR 96 CASE
Program Definition Item 78 Item 80
Family Assist Family income = or less than the Family Assist standard - (dash) 158

FamilyCare Assist

(Adults)

Income greater than FA standard but less than or = Family Health *Spenddown standard - (dash) 158

FamilyCare Assist

(Adults)

Income greater than Family Health *Spenddown standard but = or less than PA standard - State insurance not available. A 158

FamilyCare Assist

(Adults)

Income greater than Family Health *Spenddown standard but = or less than PA standard - State insurance available. F 158
deleted text

new text*The Family Health Spenddown program ended for non-pregnant adults in Family Health Plans effective January 2014.

BACK TO TOP

ITEM 78 CODES FOR PERSONS UNDER AGE 19 IN A 94 OR 96 CASE
Program Definition Item 78 Item 80
Family Assist N/A (-), 3, C 158
All Kids Assist revised textIncome above FA standard, = or less than 147% of FPL; - child not previously coded C in Item 78 R 158
All Kids Assist revised textIncome above FA standard, = or less than 147% of FPL; - child was previously coded C in Item 78 T 158
Moms & Babies Newborn born to Medicaid eligible mother P 158
Moms & Babies Newborn born to Medicaid eligible mother who doesn't meet the immigration requirement N 158
Moms & Babies Pregnant P 158
Family Health Spenddown N/A - (dash) 158, 390
Extended medical N/A - (dash) 158

BACK TO TOP

ITEM 68 CODES FOR ALL 94 AND 96 CASES
Definition Code
Uninsured person - no state health insurance available - (dash)
Insured person - no state health insurance available 1
Uninsured person - state health insurance available 2
Insured person - state health insurance available 3

BACK TO TOP

ITEM 73 FOR All Kids SHARE AND PREMIUM
Program Item 73 Item 80
Share Y 177
Share (eligible for **Rebate - chose Share) J 177
Premium Levels 1-8 Z 177
Premium (eligible for **Rebate - chose Premium) L 177
Rebate (income = or less than 150% of FPL) V 177
Rebate (income greater than 150% of FPL) X 177

new text** The Rebate program ended effective January 2014.

Other Medical Programs

Health Benefits for Workers with Disabilities

HBWD Office #250

revised text2014 Income Standard

Less than or Equal to 350% FPL

1 $3,404 6 $9,325
2 4,588 7 10,509
3 5,772 8 11,693
4 6,956 9 12,877
5 8,140 10 14,061
  • Each additional person: Add $1,184
  • Asset limit $25,000 

Illinois Healthy Women

IHW Office #190

revised text2014 Income Standard

Less than or Equal to 200% FPL

1 $1,945 6 5,328
2 2,622 7 6,005
3 3,298 8 6,682
4 3,975 9 7,359
5 4,652 10 8,036

QMB Case Coding

Program Item 60
QMB/Medicaid 1
SLIB/Medicaid 2
QI-1 Spenddown 3
QI-1 Only 7
SLIB Only 8
QMB Only 9

BACK TO TOP

Program* District Office Eligibility Determination Case Maintenance
Illinois Cares Rx** MMIS** Dept. on Aging HFS
IL Breast & Cervical Cancer 189 Dept. of Public Health All Kids Unit
Illinois Healthy Women 190 All Kids Unit All Kids Unit
HFS Social Services 194 Central Action HFS
DHS Social Services 193 Central Action DHS
Incarcerated Persons 195 All Kids Unit All Kids Unit
Veterans Care 196 Veterans Care Unit Veterans Care Unit

*Except for Illinois Breast & Cervical Cancer and Veteran's Care, these programs provide limited benefits only and should not be considered active coverage when determining eligibility for other benefits, including other medical programs.

**MMIS is Medical Management Information System. Illinois Cares Rx (formerly Illinois Cares Rx) appears under a special eligibility segment; find by RIN. Persons do not appear in PACIS when receiving Illinois Cares Rx only.