WAG 06-08-02-a

Nonfinancial eligibility factors for All Kids/FamilyCare Share, Premium and Rebate are the same as for Assist, except for the additional requirements listed below.

  • A person cannot be eligible for Moms & Babies or Assist, including met spenddown.
  • A person cannot be a patient in an institution for mental disease, even if the person is in a Medicaid-covered setting.
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  •  For FamilyCare Rebate an adult must:
    • Have at least one child living with them who is enrolled under any All Kids Plan; for FamilyCare Share and Premium, the adult must at a minimum live with a child who meets the nonfinancial eligibility criteria, and 
    • cannot have access to a State of Illinois-administered health insurance plan.

NOTE: A person does not have access to a State-administered health insurance plan if the person who could carry the insurance does not live in the home.

  • For All Kids/FamilyCare Rebate:
    • the person's insurance must cover at least inpatient hospitalization and physician services. (A person who does not qualify for Rebate because their insurance does not cover both inpatient hospitalization and physician services may qualify for Share or Premium Level 1), and
    • the family must provide the required health insurance information from the policyholder's employer or insurance company.
  • For All Kids Premium Level 2, a child cannot have health insurance in the 12 months prior to the date of application unless they meet one of the exceptions listed below. (Health insurance is coverage that includes both hospital and physician services. Most HMO health insurance policies meet this definition.)
    • The child lost medical benefits under one of the Family Health Plans at or below 200% of the FPL (Assist, Share, Premium Level 1 or Rebate) in the 12 months prior to the month of application for All Kids;
    • The child only has COBRA insurance now or at any time in the 12 months prior to the first month of All Kids Premium Level 2 coverage;
    • The child lost insurance when a parent's job ended for any reason;
    • The child reached the insurance plan's maximum lifetime benefit limit; or
    • The child lost insurance because the noncustodial parent canceled the insurance as part of a divorce.
      • Note: Disease specific policies (such as cancer insurance), medical service specific policies (such as dental, vision, or hospital only policies) and accident policies (such as school-based insurance for grades K-12) are not considered health insurance for this requirement.

In addition:

  • An adult with income over 185% of the FPL, who was approved for FamilyCare Premium Levels 1-3 on or before June 30, 2009, cannot have access to a State administered health insurance plan.
  • A person is not eligible for All Kids/FamilyCare Rebate if the person previously received All Kids/FamilyCare Premium (any level) and has unpaid premiums (see PM 06-08-09-a). There are special procedures for handling All Kids/FamilyCare Share and Premium applications if the person has unpaid premiums (see PM 06-08-09 and WAG 06-08-09).
  • A person is not eligible for All Kids/FamilyCare Share or Premium if the person previously received Rebate and has an outstanding overpayment (see PM 06-08-12).