For special guidance for backdating medical benefit, review the following Medical Morsel: Case Progression and When to Approve Applicant for AABD dated 04/11/2014.
(FCRC) Determine eligibility for medical backdating for each specific month in the 3-month backdate period.
NOTE: Do not approve medical backdating for any month before the month a person meets Illinois residency requirements.
The way medical backdate eligibility is approved depends on:
- for AABD, the amount of nonexempt resources for each backdate month, using the verified amount on the first day of each month backdating is requested; and
NOTE: Also consider the transfer of resources when determining beginning eligibility for medical long term care payments (see WAG 07-02-20).
- the amount of countable income received during the backdate month; and
- whether or not the backdate month or months are consecutive (see explanation in next section).
NOTE: These conditions apply to TANF Cash, FamilyCare Assist, All Kids Assist, and AABD applications. Approval also depends on meeting nonfinancial factors.
View backdated months as consecutive if the backdated month(s) are immediately before the month in which the application was filed. This means:
- the first calendar month before; or
- the first 2 calendar months before; or
- all 3 calendar months before the calendar month in which the application was filed.
For applications not processed through AIS, identify the eligible backdated month(s) on these forms:
- AABD MAG Computation (Form 2382); and
- Nursing Home/Supportive Living Facility Calculation (Form 2500).
For TANF Cash, FamilyCare Assist, and All Kids Assist:
- TANF Cash Computation (Form 2383C); and
- Supplement to Form 2383C - TANF Cash Computation (Form 2383B), if required; or
- TANF MANG Computation Sheet (Form 2383A).
Medical Backdating for Cash and Regular Cases
Medical Backdating for Consecutive Months
(FCRC) If a person(s) is eligible for medical backdating on an AABD Cash, TANF Cash, FamilyCare Assist, All Kids Assist, or AABD Medical case, and the backdate months are consecutive:
Approve the backdating in either AIS or IPACS, as allowed.
- Enter in Item 77 the first day of the earliest consecutive month that backdated medical eligibility begins.
(System) If not suppressed, sends Form 360C which:
- provides information about eligibility for medical backdating for each person(s) included in the AABD or TANF approved case, unless the applicant declines medical backdating;
- lists the names of the person(s) who are ineligible for medical backdating; and
- identifies the month(s) that the person(s) is ineligible for medical backdating, and the reason for ineligibility.
Medical Backdating for Non-Consecutive Months
(FCRC) For AABD/TANF Cash or MANG cases, when eligibility for medical backdating is approved for a month(s) that is not consecutive:
- Complete and send the Request for Correction/Addition to MMIS Medical Eligibility File (Form 2958), to the Exception Processing Unit (EPU) in Springfield.
NOTE: Send Form 2958 whether the application is approved via AIS or IPACS.
- For each month, enter the beginning and ending medical eligibility date.
NOTE: Form 2958 requests approval of medical coverage for the non consecutive month(s). The MMIS Medical Eligibility File cannot be updated via FCRC computer entry when a backdated month is a non-consecutive month. EPU performs this function.
(FCRC) For TANF cash and AABD MANG/All Kids Assist/Moms and Babies cases processed via AIS:
- On the AIS Medical Generic Screen, enter the correct denial TAR, by person. Use any of the denial TARs that are valid with TA 05, Denial.
- On the AIS Medical Backdate Screen, enter the:
- eligible non-consecutive month(s); and
- reason for ineligibility for any ineligible month(s).
NOTE: Form 2958 must be sent to Springfield to authorize medical backdating for any non-consecutive month.
(System) When not coded to suppress, sends the Notice of Decision on Application for Cash, Medical, and/or SNAP (Form 360C), and advises the person about:
- which non-consecutive backdate month(s) was approved for medical backdating; and
- which month(s) was not approved for medical backdating and the reason for ineligibility.
Example: The person files an application for AABD cash and medical benefits on 09/12/12. The person requested medical backdating for the months of June, July, and August. Cash benefits are approved and start on 10/12/12.
A determination of eligibility was made for the 3 backdate months as follows:
August - eligible;
July - not eligible (countable assets over the limit);
June - eligible.
To process medical coverage for August (a consecutive month), the FCRC enters 08/01/12 in Item 77 on the proper AIS screen, when approving the case.
To process medical coverage for June (an eligible non-consecutive month), the FCRC sends Form 2958 to the Exception Processing Unit in Springfield. Form 2958 requests medical backdating and updating the MMIS Medical Eligibility File for the June calendar month (06/01/12 through 06/30/12).
On the AIS Medical Backdate Screen, the FCRC also enters:
- the month of June as an eligible non-consecutive month; and
- the reason for ineligibility for the month of July.
Form 360C advises the person of the eligible medical backdate months (08/12 and 06/12), and the month the person was found ineligible for medical backdating (07/12). Form 360C also gives the reason why the person was ineligible for medical backdating in 07/12.
(FCRC) Send all required pages and subsections of the Notice of Decision on Application for Cash, Medical, and/or SNAP - Local (Form 360 Series), when a case:
- is not processed through AIS; and
- is eligible for a medical backdate month(s) which is not consecutive.
NOTE: For applications approved through IPACS, Form 360C is not sent when medical coverage is not backdated for the full 3-month backdate period.
Complete and send the Form 360 series. Subsection, Medical Backdate (Form 360F), informs the person about:
- ineligibility for backdating;
- the month(s) ineligible for backdating; and
- the reason for backdating ineligibility.
Spenddown Backdating for Cash Cases (AABD, TANF)
(FCRC) Complete and send Form 2958 to the Exception Processing Unit (EPU) in Springfield when:
- an AABD or TANF cash application is eligible for spenddown medical backdating; and
- the medical backdating is for any or all of the 3 months before the month of application.
Enter the following information on Form 2958:
- For each month, enter the beginning and ending medical eligibility date.
- For each spenddown month, enter the split bill day (the date that spenddown is met is the split bill day).
NOTE: Do not request approval for medical backdating for any spenddown month(s) unless the spenddown is met.
(System) When coded not to suppress, sends Form 360C for:
- TANF cash cases approved through AIS; and
- AABD cash cases approved through IPACS.
If medical eligibility is backdated for an AABD or TANF Cash case and at least one of the backdate months is a spenddown month, Form 360C:
- notifies the applicant of the AABD or TANF cash approval; but
- does not give information about medical coverage for the backdate period.
(FCRC) To notify the person of medical backdating when one of the months is spenddown, complete and send the applicant the Backdate Supplement To Notice of Decision on Application for Assistance Grant (Form 360B).
- Form 360B informs the person about their eligibility and spenddown status (met or unmet) for the backdate month(s) they requested medical coverage.
- Form 360B is a supplement to the centrally sent Form 360C when medical eligibility is backdated for an AABD or TANF cash application and at least one of the backdate months is a spenddown month.
NOTE: Do not send Form 360B when the Form 360 series is sent instead of the centrally generated Form 360C. In this situation, complete subsection Medical Backdate (Form 360F), to notify the person of their eligibility for medical backdating.
Follow these steps when using Form 360B:
- Check the proper box on the Form 360B for each month the person requested medical backdating.
- Complete Form 360B in duplicate.
- Mail the original to the person the same day the application is approved on the computer system.
- Place the copy in the case record.
Approving Medical Backdating Under a Different Category
(FCRC) When a TANF Cash or All Kids Assist/Moms and Babies application is approved through AIS and a customer(s) is eligible for medical backdating under a different program category:
- Process a TA 10 (Approve and Cancel) via IPACS for the medical backdate month(s) only;
- Do not locally send the person an approval notice for the medical backdate decision under the different category;
- Enter all information about the medical backdate month(s) on the AIS Medical Backdate Months Screen, using the original category that the cash or MANG application was approved.
(System) Sends Form 360C notifying the person of all application requests, and the decision regarding medical backdates.
(FCRC) When an AABD/TANF Cash or AABD MANG/All Kids Assist/Moms and Babies application is approved through IPACS and a customer is eligible for medical backdating under a different program category:
- Register an application under the correct category for the backdate months;
- Process a TA 10 (Approve and Cancel) via IPACS for the medical backdate months only;
- Notify the customer of all application requests, and their eligibility for medical backdating.
- Send Form 360F for the medical backdate, and all other required pages and subsections of Form 360 series.
- Show the medical backdate approval as being under the original TANF category. Do this even though the medical backdate was provided under a different category.
For MANG, when the original application is approved, enter information on medical eligibility for the backdate period in the proper section on the Notice of Decision on Application for Medical Assistance - MANG Non Spenddown (Form 458).