WAG 02-05-04

IES Phase 2 Process

Children under the age of 19 are presumptively eligible (CPE) for medical benefits when an application is received if:

  • Declared gross family income is equal to or less than revised text209% of the FPL;
  • new textDeclared state of residence is Illinois;
  • revised textDeclared the child is a U.S. citizen or has satisfactory immigration status; and
  • The child did not start receiving PE coverage (including MPE) within one of the last 12 months.

revised textTo determine eligibility for child PE, no further information or verification is required. Child PE is authorized for any application that includes a request for medical benefits including those registered for all Family Health Plans as well as TANF and AABD.

If the applicant fails to declare Illinois residence, U.S. citizenship or satisfactory immigration status, family size and monthly income, or leaves these questions blank on the application, deny child PE. If the applicant fails to respond to these questions on the application or fails to provide information during a face to face or telephone interview, the applicant has not made a declaration.

During the CPE period, the child receives the same medical benefits as children receiving Family Assist or All Kids Assist. There are no copays or premiums during the CPE period.

No revised text HFS Medical Card is issued.

revised textThe number of people in the household, including unborn children of pregnant women, and total declared income is used to determine CPE. deleted text

Request to Add a Child to an Existing Medical Case

new textEffective with IES Phase 2 implementation, CPE may be authorized for a child when a request to add the child for medical benefits is received on an active case.  CPE is authorized for eligible children if the criteria above are met.  Verification may be needed for on-going regular eligibility.

Legacy Process

Children under the age of 19 are presumptively eligible (PE) for medical benefits when an application is received if:

  • declared family income is equal to or less than 200% of the FPL;
  • the child did not start receiving PE coverage (including MPE) within one of the last 12 months; and
  • the worker has no knowledge that the child does not meet citizenship/ immigration requirements.

This includes applications registered for all Family Health Plans as well as TANF and AABD.

During the PE period, the child receives the same medical benefits as children receiving Family Assist or All Kids Assist. There are no copays or premiums during the PE period. Also, no Medical card or All Kids ID Card is issued.

Gross family income is used to determine PE eligibility. The normal deductions, such as the earned income deduction or child care, are not allowed. The system uses regular income-averaging to determine monthly income.