WAG 18-05-10.

IES Phase 2 Process

When a change in income is reported that may result in a child's medical eligibility changing to a lower cost program, the income change must be verified before certifying in IES. However, certain non-income related changes may also result in a change in medical to a lower cost program. These changes do not require proof of household income provided the household is not due or overdue for a redetermination and there has been no reported change of income.

Income Related Changes Resulting in Assist Eligibility

revised text If the family reports that income changed and the income of a person receiving All Kids Share or All Kids Premium falls below the Assist income standard the family can request that eligibility for the child be determined for Assist or Moms & Babies. To receive Assist or Moms & Babies, the family must verify current income.  If the income is not verified, the children will remain active in All Kids Share or All Kids Premium until the next renewal.

Non-Income Related Changes Resulting in Assist Eligibility

new text Non-income related changes to an All Kids Share or Premium household includes the following:

  • The addition of a child which increases the size of the medical Eligibility Determination Group (EDG) in IES; or
  • The annual increase in the federal poverty level (FPL) which may be sufficient for some children to qualify for a less costly medical program.

Increased EDG Size

new text Countable income of the child being added to the household must be verified. See PM 15-06-01-h to determine if a child's income is countable under MAGI budgeting. However, the income of other household members does not have to be verified if there is no reported change to the income and the household is not due or overdue for a redetermination.

Increased Income Standard from the Annual FPL

new text There are three ways children may be shifted to a lower cost medical program due to the increased standards from the annual change in the FPL. To qualify for a shift in program without new verification of income, the household must not be due or overdue for a redetermination and not have reported a change in income. IES will send a Form 360C Notice of Decision if a child is moved to a less costly medical program.

  1. Families may request a new eligibility determination based on the increased income standards resulting from an increase in the FPL. Process the request in IES without requesting verification of income.
  2. While certifying other changes including a REDE in IES, caseworkers may also shift children from active medical cases to a lower cost medical program.
  3. At the sole discretion of Healthcare and Family Services (HFS), IES may automatically shift children in active medical cases to a lower cost medical program as part of a central update.

In situations involving conflicting information, verification may be required. Contact HFS medical policy for guidance at 217-557-7158.

Legacy Process

If the family income of a person receiving All Kids Share, All Kids Premium, or All Kids Rebate falls below the Assist income standard, the family can choose for the child to stay on All Kids Share, All Kids Premium, or All Kids Rebate until the next renewal, or the family can request that eligibility for the child be determined for Assist or Moms & Babies. To receive Assist or Moms & Babies, the family must verify current income.

Do not backdate All Kids Assist, Moms & Babies, or AABD Medical over a period in which a person received All Kids Rebate benefits.