PM 20-28-01.

  1. (DoA, DHS) DoA, DHS - DDD, or DHS - DRS completes and sends the Interagency Request for Income/Assets Information for In-home Care Applicant or Recipient (Form 2538) to Family Community Resource Center.
  2. (Client) Completes consent form to release information for each specific contact outside DHS. A consent statement is not required to release information available in the case record or to obtain information from public records.
  3. (FCRC) Date stamp Form 2538 when received from DoA or DHS.
  4. (FCRC) Check to make sure that signed consent form is attached, when needed.

    NOTE: DoA will attach the Consent to Release of Information (Form 34) or DoA's IL 402-0184, Release Information Form, when a consent form is needed. 

  5. (FCRC) Return Form 2538 to DoA, DHS - DDD, or DHS - DRS when there is not a required consent form attached.
  6. (FCRC) Review case record if applicant is a DHS client for income or asset information needed to complete Form 2538.
  7. (FCRC) Complete Section B of Form 2538 to report person's financial eligibility status if in-home care individual is a cash or regular medical client, or an approved applicant.
  8. (FCRC) Complete Section C of the Form 2538 to report person's financial eligibility status if in-home care individual is a spenddown client or their cash or medical application was denied.
  9. (FCRC) Complete Section C of Form 2538 for non-DHS clients.
  10. (FCRC) Attach copy of needed verifications.
  11. (FCRC) Return Form 2538 to DoA, DHS - DDD, or DHS - DRS within 14 workdays, starting with day the form is received in Family Community Resource Center.
  12. (FCRC) Immediately notify DoA, DHS - DDD, or DHS - DRS if more information is needed to verify person's income or assets and 14-day time frame may not be met.
  13. (FCRC) Send 2nd request for verifications if not received within 30 calendar days.
  14. (FCRC) Return Form 2538 to DoA, DHS - DDD, or DHS - DRS as soon as the verifications are received.

If information is not received within 60 calendar days:

  1. Indicate in "Remarks Section" of Form 2538 that verification is pending.
  2. Send copy of Form 2538 to DoA, DHS - DDD, or DHS - DRS.
  3. Immediately send any verifications received to DoA, DHS - DDD, or DHS - DRS when received.
  4. (DoA or DHS) May resubmit copy of Form 2538 with needed information.
  5. (FCRC) Date stamp copy of Form 2538 and begin process again.

In-home Care Services Through DoA (Medical only)

  1. (CCU/CMU) Case coordination/case management units (CCU/CMU) under contract with DoA use the IDoA Notification (Form 2538B) to notify local offices of persons applying for or receiving in-home care services through DoA (DoA services). DoA services are also referred to as DoA Community Care Program services.
  2. (CCU/CMU) Gives Form 2538B to persons who are not active, but who intend to apply for medical benefits. Also, gives these persons the Mail-in Application for Medical Benefits (Form 2378H).
  3. (CCU/CMU) Instructs persons applying for or receiving DoA services, who are not active but who intend to apply for medical benefits, to provide local offices with both Form 2538B and Form 2378H when applying for medical benefits.
  4. (CCU/CMU) For active medical cases, sends Form 2538B to local offices as notification of clients applying for or receiving DoA services.
  5. (CCU/CMU) Sends Form 2538B to local offices to report changes of information.
  6. (FCRC) Send, as appropriate, a copy of the following forms to the CCU/CMU under contract with DoA:
    • Form 157 as notification of a penalty period;
    • Notice of Decision on Application for Medical Assistance - MANG Non-Spenddown (Form 458) for denials and regular MANG approvals;
    • Notice of Decision on Application (MANG) for a MediPlan Card (Form 458SP) for cases approved with a spenddown; and
    • Assessment of Assets (Form 3190) as notification of the assessment of assets.

      Do not send Form 2538B to agencies under contract with DoA. DoA is responsible for distribution of this form.

      Do not require a new Form 2538B at REDE. Agencies under contract with DoA will submit changes of information as necessary.