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6/6/12

Obsoletes policy memorandum dated 6/30/09

Summary:

  • As part of cuts to Healthcare and Family Services' budget for fiscal year 2013, FamilyCare Share, Premium and Rebate for adults is ending effective 7/1/12. 
  • Effective immediately, staff must not approve new applications for adults for FamilyCare Share, Premium or Rebate; a manual process for denying eligibility for adults with income over 133% in AIS is included in this memorandum.
  • Staff will be notified when system changes are in place to prevent approvals of adults for FamilyCare Share, Premium and Rebate.
  • Staff in the All Kids unit will delete or cancel adults active in FamilyCare Share, Premium and Rebate for cases active in office 180 and in DHS Family Community Resource Centers (FCRCs).
  • In addition to the central notice generated through AIS and ACM, adults currently receiving FamilyCare Share, Premium or Rebate will also receive a separate central notice advising them of this change.
  • FamilyCare adults with income over 133% of the FPL may still qualify for Family Health Spenddown.
    1. Pending Applications for FamilyCare Share, Premium and Rebate
      1. AIS
    2. Active FamilyCare Share, Premium and Rebate Cases
      1. Notices
    3. Appeals
    4. Forms referenced:

In response to passage of the Save Medicaid Access and Resources Together Act (SMART Act), eligibility for adults on FamilyCare Share, Premium and Rebate ends at midnight 6/30/12.  Effective immediately, do not approve a parent or caretaker relative for FamilyCare Share, Premium or Rebate.

Pending Applications for FamilyCare Share, Premium and Rebate

Review eligibility for all other medical programs before denying an adult for FamilyCare Share, Premium or Rebate:

  • If pregnant, review eligibility for Moms & Babies;
  • If age 65 or older, review eligibility for AABD;
  • If receiving Social Security Disability (SSDI) or Supplemental Security Income (SSI), review eligibility for AABD; and
  • If medical expenses were submitted with the application, review eligibility for spenddown.

Until the system changes are in place, take the following action for pending medical requests for parents and caretaker relatives whose countable income is more than 133% of the FPL.

AIS

When the case progression screen shows FamilyCare Share, Premium or Rebate eligibility for the adult, hit F1 to cancel the option 8 action.  Go to the Add/Change/Delete function and split off the adult into a separate case.  Deny the adult's case through Option 5 using Type Action Reason (TAR) 42 and code 00 in Item 39 to generate the central notice 360C. 

Note: Do not change the adult from a requestor to a non-requestor because a central notice is not generated in that situation.

Active FamilyCare Share,  Premium and Rebate Cases 

Effective for 7/1/12, the All Kids unit will delete or cancel the adults in FamilyCare Share, Premium and Rebate for office 180 as well as the cases active in the FCRCs.  The All Kids unit will use the DHS nodes to make the necessary changes to the cases active in the FCRCs.

The state law change also applies to parents and caretaker relatives with income above 185% FPL up to 400% FPL who continued to receive FamilyCare Premium Levels 1-3 benefits since June 2009 when FamilyCare was reduced for new applicants to 185% FPL.

Eligible women losing FamilyCare Share and Premium will be centrally enrolled in Illinois Healthy Women. 

Notices

When deleting an adult from a FamilyCare Share, Premium or Rebate case, use TAR 12 and code 00 in Item 39 to generate Form 157 Notice of Change.

When canceling an adult-only FamilyCare Share, Premium or Rebate case, use TAR D7 and code 00 in Item 39 to generate Form 157 Notice of Change.

A client notice CN/S 12.14 Important News About Your Medical Benefits (pdf)  will also be centrally mailed to the adult to explain the change in state law.

Appeals

Appeal rights do not apply if the reason for the appeal is that the client disagrees with the law change. However, the client has the right to appeal and be given a fair hearing if they believe that they remain eligible for medical benefits due to an error in the eligibility determination regarding their income or family size, or that they are eligible due to having a disability. In those situations, follow policy contained in PM 01-07.

[signed copy on file]

Michelle R. B. Saddler

Secretary, Illinois Department of Human Services

Julie Hamos

Director, Healthcare and Family Services

Forms referenced:

  • Form 157
  • Form 360C
  • CN/S 12.14