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 |
| Family Health Spenddown |
Income greater than FamilyCare Premium/Rebate standard. |
- (dash) |
158, 390 |
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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 |
Income above FA standard, = or less than 133% of FPL; - child not previously coded C in Item 78 |
R |
158 |
| All Kids Assist |
Income above FA standard, = or less than 133% 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 |
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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 |
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ITEM 73 FOR All Kids SHARE, PREMIUM, AND REBATE
| 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 |
Other Medical Programs
Health Benefits for Workers with Disabilities
HBWD Office #250
2013 Income Standard
Less than or Equal to 350% FPL
| 1 |
$3,351 |
6 |
$9,214 |
| 2 |
4,524 |
7 |
10,386 |
| 3 |
5,696 |
8 |
11,559 |
| 4 |
6,869 |
9 |
12,732 |
| 5 |
8,041 |
10 |
13,905 |
- Each additional person: Add $1,173
- Asset limit $25,000
Illinois Healthy Women
IHW Office #190
2013 Income Standard
Less than or Equal to 200% FPL
| 1 |
$1,915 |
6 |
5,265 |
| 2 |
2,585 |
7 |
5,935 |
| 3 |
3,255 |
8 |
6,605 |
| 4 |
3,925 |
9 |
7,275 |
| 5 |
4,595 |
10 |
7,945 |
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.
