WAG 18-05-01.

Once determined eligible, a person under 19 is eligible for Medicaid for 12 months from the last eligibility determination.

This applies to categories 04, 06, text deleted92, 93, 94, and 96.

Continuous Medicaid eligibility applies to persons under 19, including a caretaker relative and their spouse, if under age 19. It does not apply to persons determined eligible for Medicaid as:

  • spenddown met; or
  • emergency medical for noncitizens; or
  • PE; or
  • MPE.

Once a person under 19 is determined eligible for Medicaid (except for the 4 situations listed above), they are eligible for Medicaid, regardless of changes in income or living arrangement from that month through 12 months following the date eligibility date is determined. They are eligible unless they:

  • reach age 19;
  • move out of the State of Illinois;
  • were incorrectly determined eligible in the first place;
  • are a parent and refuse to cooperate with child support/medical support rights;
  • fail to cooperate with the SSN requirement; or
  • request cancellation.

The continuous Medicaid eligibility period begins with the month in which the eligibility determination is made (unless the family is only eligible for spenddown) and continues for 12 months after that month, for a total of 13 months.

When a child enters a jail or juvenile detention facility, they only qualify for hospital and professional services rendered during the hospital stay.  Do not terminate a child's medical benefit because they are detained in a jail or juvenile detention facility. Refer to PM 03-23-01.