1. (Applicant) Completes Moms & Babies (Medicaid Presumptive Eligibility) (Form 3089) at the qualified provider's office.
  2. (Provider) Completes Section III of Form 3089.
  3. (Provider) Advises the pregnant woman who wants to apply for cash, SNAP, or assistance for her spouse, of the requirement to apply at the Family Community Resource Center.
  4. (Provider) Writes Medical - All Kids Application To Follow in the upper right-hand corner of Form 3089.
  5. (Provider) Faxes Form 3089 to the HFS Central All Kids Unit at 1-217-557-5046.
  6. (Provider) Helps the applicant complete the All Kids Application (Form 2378MC).
  7. (Provider) Distributes Form 3090KC:
    • original to the woman and
    • copy in the provider's case file.
  8. (Provider) Takes the following actions when pages 1, 2, 3, and, if applicable, page 5 are completed and all required documentation has been received.
    1. Writes All Kids Application Attached in the upper left-hand corner of Form 3089.
    2. Attaches the completed Form 2378MC to the back of Form 3089.
    3. Mails the completed Form 2378MC application, Form 3089, and required documentation to:

      HFS Central All Kids Unit
      P.O. Box 19122
      Springfield, IL 62794-9122 

  9. (Provider) Calls the HFS Central All Kids Unit at 1-877-805-5312 if the pregnant woman needs medical care before her temporary card is mailed (3-5 days).
  10. (FCRC/All Kids Unit) Receive original or faxed copy of MPE application (Form 3089) within 5 workdays from when the provider found the woman MPE eligible.
  11. (FCRC/All Kids Unit) Process Form 3089 to authorize MPE coverage and issue the MediPlan Card (see WAG 06-10-02-b).
  12. (FCRC/All Kids Unit) Notify the All Kids Coordinator when there are continuing problems with the All Kids Application Agent getting the MPE Application to the HFS Central All Kids Unit within the 5-workday deadline.