The REDE form is sent to NH and SLF customers by Maximus, an external vendor and part of the Illinois Medicaid Redetermination Project (IMRP), when the redetermination is due. Other medical cases will be verified electronically and contacted by Maximus only if additional information is needed.
Never ask a person to come to the FCRC to complete a REDE.
The only verification required at REDE is:
- current income;
- current resources;
- disability for 93 cases and blindness for 92 cases, if there is a CAU reexam date or they no longer receive SSI or SSA;
- documentation of citizenship and identity for U.S. citizens if not yet documented; and
- Illinois residency for medical-only customers who live in the community and are not centrally redetermined (see WAG 19-02-03-b).
Accept the customer's statement for Illinois residency for all other cases unless it is questionable. To be allowed, support paid as a deduction from income must be verified.
Always review TPL information at each REDE and complete the necessary forms.
For noncitizens, USCIS status must be verified through SAVE (Systematic Alien Verification of Entitlements), if the status is subject to change or proof through SAVE has not already been obtained.
For U.S. citizens, documentation of citizenship and identity is required (see PM 03-01-01). Complete an SSA citizenship inquiry for each person for whom citizenship and identity has not yet been documented (see PM 22-14-03-e). If citizenship and identity cannot be confirmed via the SSA inquiry, send the customer a request (Form 1721 with Form 3859A-Help Sheet for Citizenship & Identity Documentation) to provide documentation within 3 months. If otherwise eligible, process the REDE while documentation is pending and set a control or flag the case for follow up.
If the required documents are not provided by the end of the 3-month period, cancel or delete the person from medical assistance unless the person is:
- a child under age 19 (enter code 47 in Item 74); or
- an adult who had an active case AND has been continuously living in a nursing home, CILA, or SLF since 11/30/11 or earlier (enter code 47 in Item 74).
Note: Children may receive Home and Community Based Waiver Care (HCBC) Services through age 21 (Item 80 contains code 335). Contact HFS Medical Eligibility and Special Programs ("Policy") for guidance prior to taking negative action on an HCBC case.
Explain the Health Insurance Premium Payment (HIPP) Program to customers if they have high-cost medical conditions and have health insurance available to them.
For customers in nursing homes, a review of ongoing eligibility includes a review of each customer's personal funds and room and board accounts.
For NH, SLF, and Medical customers applying for or receiving DoA services, review any resource transfers by the customer or the customer's spouse by following PM 07-02-20. To determine the application of nonexempt income, see PM 15-04-04.
For NH, SLF, and Medical customers applying for or receiving DoA services, verify the income of the community spouse or dependent family members to determine if the customer's income may be diverted to meet the needs of those family members in the following situations only:
- The customer requests his or her income be diverted to the community spouse or dependent family members and no diversion of income is currently being made; or
- The customer requests to give the January Social Security Cost of Living Adjustment (COLA) to the community spouse or dependent family members; or
- A change in income is reported or a recalculation of the diverted income is requested.