PM 17-02-04.

(FCRC) For AABD Medical/All Kids Assist/Moms and Babies applications, approve medical benefits effective the first month medical eligibility is established. However, do not approve medical benefits earlier than the third month before the month of application. See WAG 17-02-05-a for complete information on backdating medical eligibility.

NOTE: For AABD Medical applications, enter code 8 in Item 73 to approve a child under age 21 living in a DHS facility or enter code 9 for a child living in a non-DHS facility. The policy for 3 months of medical backdating applies for children under age 21 who live in a DHS-operated facility.

If the only reason a community spenddown applicant is being enrolled in spenddown is because they need a transplant, a statement is required from the transplant center.

If an applicant has an active case in another state, contact the state and advise them to cancel their case. Also, ask if they will pay for their customer's medical bills which were incurred in Illinois.

NOTE: Medical benefits may be provided when the other state will not pay for medical bills incurred in Illinois and all other eligibility factors have been met.

Approval Process Via AIS

AIS automatically generates ACID and ANQR inquiries for each application. This determines if anyone included in the unit received benefits in Illinois in the past 2 years. If anyone received benefits in the past 2 years, get the RIN from the ACID or ANQR inquiries. Enter it on the correct AIS screen.

NOTE: Do not require ACID and ANQR inquiries when approving an application for persons who were enrolled for MANG within the last 4 months.

AABD MANG/All Kids Assist/Moms and Babies applications approved through AIS require the eligibility worker to enter specific information onto a series of AIS screens. The system codes Form 552 based on the information entered.

NOTE: For RRA MANG applications, also see WAG 06-01-09 for help in processing the approval.

Process all AABD MANG/All Kids Assist/Moms and Babies applications through AIS unless:

  • the system is not operational; or
  • it is an exception situation where AIS cannot process the application.

When AIS cannot process the application, complete a blank Form 552 for IPACS approval. See WAG 25-08-01-b for All Kids Assist/Moms and Babies or WAG 25-08-02-b for AABD.

Notices of Decision

See WAG 25-02-06 for charts titled, Disposition Notices to Applicants. These charts show when to send Form 360C, Form 360 series, and other approval/denial notices.

Community Regular MANG Cases

The following notices are used for community regular MANG approvals:

Form 360C (Central Notice)

(System) Sends the Notice of Decision on Application for Cash, Medical, and/or Food Stamps (Form 360C), when:

  • a community regular MANG, QMB Only, or SLIB Only, case is approved; and
  • the original request did or did not include a cash request; and
  • the approval is processed through AIS; and
  • the notice is not suppressed (enter Code 00 in Item 39 on the correct AIS screen).

The system performs the following functions regarding the central notice process:

  • Identifies the person(s) approved for community regular MANG, QMB Only, or SLIB Only benefits;
  • Identifies the person(s) denied AABD/TANF cash, community regular MANG, QMB Only, or SLIB Only, and gives the reason why they were found ineligible.

If a request for FS is made with the MANG application:

  • identifies the person(s) approved for FS;
  • identifies the person(s) denied FS; and
  • gives the reason why they were found ineligible.
Suppressing the Central Notice of Decision
AIS Approvals

(System) For some MANG approvals a central notice is not generated when the application is processed through AIS. In these situations, the system automatically enters the correct Item 39 code to suppress the central notice.

  • Enters Code 80 for community spenddown approvals without food stamps.
  • Enters Code 92 for MANG approvals with food stamps.

(FCRC) NOTE: For these approvals, manually send the correct notice of decision.

IPACS Approvals

For all MANG approvals (except for RRA) a central notice is not generated when the application is processed through IPACS. In these situations enter the correct code, 80 or 92, in Item 39 on Form 552.

NOTE: For these approvals, manually send the correct notice of decision.

Form 360 (Local Notice)

(FCRC) Send the Notice of Decision on Application for Cash, Medical, and/or Food Stamps - Local (Form 360 series), when:

  • a community regular MANG case is approved; and
  • the original request included a cash request; and
  • the approval is processed through IPACS.

Enter Code 80 or 92 in Item 39 on Form 552.

Form 458 (Local Notice)

(FCRC) Send the Notice of Decision on Application for Medical Assistance - MANG Non Spenddown (Form 458), when:

  • a community regular MANG case is approved; and
  • the original request did not include a cash request; and
  • the approval is processed through IPACS.

Enter Code 80 or 92 in Item 39 on Form 552.

For All Kids Assist/All Kids Moms and Babies, if any person(s) is ineligible to be included in the case, list the ineligible person(s) and the reason for ineligibility on the notice.

NOTE: Also send the Notice of Decision on Application for Payment of Medicare Premiums, Deductibles and Coinsurance (Form 458M) when a unit member claims to be a Medicare Part A beneficiary.

Community Spenddown Cases

The following notices are used for community Spenddown approvals:

Form 458SP (Computer Generated)

(System) The FCRC computer generates the Notice of Decision on Application (MANG) for a MediPlan Card (Form 458SP), when:

  • a community spenddown case is approved; and
  • the original request did or did not include a cash request; and
  • the approval is processed through AIS.

Form 458SP (Manual Notice)

(FCRC) Send the Notice of Decision on Application (MANG) for a MediPlan Card (Form 458SP), when a community spenddown application is approved through IPACS.

For both the computer-generated and manual Form 458SP, also send Form 458M when a unit member claims to be a Medicare Part A beneficiary.

MANG Long Term Care Cases

(FCRC) Send the Revised textNotice of Decision on Application for Medical Assistance - MANG Nursing Home/Supportive Living Facility (Form Revised text458LTC) when:

  • a MANG Long Term Care application is approved; and
  • the case is approved either through AIS or IPACS.

In addition to Form Revised text458LTC, also send the Revised textNursing Home/Supportive Living Facility Calculation (Form 2500).

Also send Form 458M when a unit member claims to be a Medicare Part A beneficiary.

NOTE: Revised textNo central notice is generated for MANG Long Term Care approvals.