WAG 06-08-05

IES Phase 2 Process

For all additions other than deemed newborns, form 243A-C Request for Medical Benefits for Another Household Member is required and asks for the person's income, tax filer and relationship information. When a request to add a child to an existing medical case is received, proof of the child's own countable income is required. See PM 15-06-01-h to determine if a child's income is countable under MAGI budgeting. Do not re-verify countable parental or sibling income, only verify the child's own income if such income is reported.

Starting with IES Phase 2, IES will pend the medical request if the child's reported countable income is not verified.

If a family completes the appropriate form to add a child, and the child qualifies for All Kids Share or Premium, add the child prospectively for the current effective month. For All Kids Premium, the premium will be increased, if appropriate, for the month the child is added.

Due to continuous eligibility policy (see PM 18-05-01), the child who is already in the case cannot be moved to a higher cost program based on the new household information, but can move to a less costly program. Coverage for the child who is added shall continue for the remainder of the original 12-month eligibility period.

Prior Coverage and Backdating

The first time the child receives All Kids Share or Premium Level 1, unless the child has previously received Rebate, the child can also receive prior coverage for 2 weeks prior to the date the request to add the child is signed. See PM 06-08-03-e for information about prior coverage.

For All Kids Premium Level 2, prior coverage is not available to children other than newborns. Newborns can receive medical benefits under Premium Level 2 effective with the month of birth if the child was born to parents who are Illinois residents at the time of birth and the signed request is made prior to the first day of the fourth month after the month of birth. Up to a 3 month backdate may be requested by the parents if they are willing to pay the child's premium from the earliest month of the backdate through the current processing month.

Example: An infant is born July 30, 2016. The newborn may be retroactively enrolled if an application is received before November 1, 2016. The parents may choose to start All Kids Premium Level 2 coverage for the newborn July 1, August 1, September 1 or October 1. Premiums will be due for the first and every subsequent month of coverage.

Some newborns qualify for health insurance (third party liability or TPL) from the date of birth through 30 days because the newborn's mother was covered on the health insurance. For Premium Level 2, the child may qualify if the insurance ends after birth. If the family requests a medical backdate, the backdate cannot be authorized over a month insurance was active.

new textNewborns Who Qualify for Moms & Babies

If the baby is born to a mother receiving All Kids Share or Premium Level 1 (or Level 2 with income at or below 213% of the FPL) at the time of birth, open a Moms & Babies case for the baby. Follow the eligibility requirements in PM 06-09-02.

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