WAG 19-02-02-b

IES Phase 2 Process

new textUpon implementation of the Integrated Eligibility System (IES) phase 2, the process for completing a redetermination is changed.

The REDE form is sent centrally to cases due for redetermination as described in PM 19-02-04. IES will determine if a medical case qualifies for auto-REDE or if a manual REDE is due.

For medical manual REDEs, check electronic sources for verification before requesting verification from the family. Verifications required at REDE are:

  • Current income;
  • Documentation of citizenship and identity for U.S. citizens if not yet documented or immigration status; and
  • Illinois residency.

Accept the client's statement for presence in the home, unless it is questionable.

Always review TPL information at each REDE and complete the necessary forms. Also report any changes relating to child support to the Division of Child Support Services.

Never ask a family to come to the Family Community Resource Center to complete a REDE.

Note:  Children may receive Home and Community Based Waiver Care (HCBC) services through age 21.  Contact HFS Medical Eligibility Policy for guidance prior to taking negative action on an HCBC case.

For U.S. citizens whose verification is not yet complete, documentation of citizenship and identity is required (see PM 03-01-01). Complete an SSA citizenship inquiry for each person for whom citizenship and identity has not yet been documented (see PM 22-14-03-e). If citizenship and identity cannot be confirmed via the SSA inquiry, IES will send a VCL (with Form 3859A-Help Sheet for Citizenship & Identity Documentation) to provide documentation within 90 days. If otherwise eligible, IES will permit certification of the medical REDE while U.S. citizenship documentation is pending and create a task for follow up.

If the required documents are not provided by the end of the 3-month period, IES will cancel medical assistance unless the person is:

  • a child under age 19, or
  • an adult who had an active case AND has been continuously living in a long term care facility, CILA, or SLF since 11/30/11 or earlier.

Note: Children may receive Home and Community Based Waiver Care (HCBC) Services through age 21. Contact HFS Medical Eligibility Policy for guidance prior to taking negative action on an HCBC case.

Legacy Process

Report that a Medical REDE was completed any time all factors of eligibility that can change are reviewed. This means income, presence in the home, and Illinois residence.

The REDE form is sent centrally to cases without SNAP benefits which appear on the PAL as due for redetermination.

Never ask a family to come to the Family Community Resource Center to complete a REDE.

The only verification required at REDE is current income, documentation of citizenship and identity for U.S. citizens if not yet documented, and Illinois residency. Accept the client's statement for child care expenses and presence in the home, unless it is questionable. For support paid to be allowed as a deduction from income, it must be verified.

Always review TPL information at each REDE and complete the necessary forms. Also report any changes relating to child support to the Division of Child Support Enforcement.

For noncitizens, USCIS status must be verified through SAVE (Systematic Alien Verification of Entitlements), if the status is subject to change or proof through SAVE has not already been obtained.

For U.S. citizens, documentation of citizenship and identity is required (see PM 03-01-01). Complete an SSA citizenship inquiry for each person for whom citizenship and identity has not yet been documented (see PM 22-14-03-e). If citizenship and identity cannot be confirmed via the SSA inquiry, send the client a request (Form 1721 with Form 3859A-Help Sheet for Citizenship & Identity Documentation) to provide documentation within 3 months. If otherwise eligible, process the REDE while documentation is pending and set a control or flag the case for follow up.

If the required documents are not provided by the end of the 3-month period, cancel or delete the person from medical assistance unless the person is:

  • a child under age 19 (enter code '47' in Item 74), or
  • an adult who had an active case AND has been continuously living in a long term care facility, CILA, or SLF since 11/30/11 or earlier (enter code '47' in Item 74).

Note: Children may receive Home and Community Based Waiver Care (HCBC) Services through age 21 (Item 80 contains code 335). Contact HFS Medical Eligibility Policy for guidance prior to taking negative action on an HCBC case.