Summary:

  • For all Family Health Plans, only one pay stub is required from each job to determine eligibility.
  • For all Family Health Plans, only one proof of unearned income received from each source is required.
  • If the family provides more than one pay stub or proof of unearned income for a month, all of the pay stubs or proof of unearned income provided should be considered.
  • Budgeting is not changed. If paid weekly, multiply the weekly amount by 4.3. If paid every two weeks, multiply by 2.15. If paid twice a month, multiply by 2.
  • For all Family Health Plans, proof of child care paid is no longer required at intake or for active cases.
  • These changes do not affect verification of income for cash or food stamps.
  • These changes are being made to assist eligible families in applying for medical benefits.
  1. Intake
  2. Active Cases

This Action Memorandum was prepared by the Illinois Department of Public Aid (DPA). DPA administers the Medicaid and KidCare programs. These programs provide medical benefits to families with children and to other persons. This information is to be used by staff of the Illinois Department of Human Services when authorizing medical benefits for persons on behalf of DPA.

In an effort to further streamline the application process and assist eligible families in applying for medical benefits, Governor Blagojevich has announced that beginning in January 2004, only one pay stub is required to determine eligibility for all Family Health Plans. For unearned income, only one proof of income received is required, even if the income is received more frequently than once a month. Self-employment records for the entire month are still required. Proof of child care paid is no longer required.

Intake

For all Family Health Plans, only one pay stub is required from each job to determine eligibility including eligibility for backdated months. For unearned income, only one proof of income received is required. The pay stub or proof of unearned income must be for income within 30 days prior to the date of application. Proof of one child support/alimony payment made is required. This proof must be of an expense paid within 30 days of the application date. Proof of child care paid is no longer required. The monthly deduction for child care expenses is limited to the amount paid up to a maximum of $200 for each child under age 2 and $175 for each child 2 or older.

Budgeting is not changed. If the person is paid weekly and provides one pay stub, multiply the gross amount by 4.3. If the person is paid every 2 weeks and provides one pay stub, multiply the gross amount by 2.15. If the person is paid twice a month, multiply by 2.

Additional proof is required only when the worker has reason to believe that the proof provided does not adequately show the family's actual income or expense for the month. An example of this would be when the client states that income was different for a backdated month. For backdated months when the client states the amount was different, the client must provide a stub for the month in question.

Example 1: Mr. C applies for medical and food stamp benefits for his family on 01/12/04. The only income is from Mr. C's employment. He provides his last four pay stubs in the amount of $100, $150, $200 and $400. He states that his income varies each week and the pay stubs provided represent what he normally makes. Use all 4 pay stubs to determine Mr. C's countable income for both medical and food stamp benefits.

If a family also applies for cash or food stamp benefits and all proofs are provided to approve medical benefits, do not delay processing the medical application while waiting for proofs needed to approve the cash or food stamp request.

Example 2: Ms. A applies for medical and food stamp benefits for her family on 01/05/04. The only income is from Ms. A's employment. She has her last pay stub from 12/26/03 in her purse. Determine eligibility for medical benefits and give Form 267 to Ms. A to provide the remaining pay stubs from the last 30 days to determine her eligibility for food stamp benefits.

Active Cases

One pay stub or proof of unearned income is required at REDE or to make an income change. Proof of one child support/alimony payment made is required.

Additional proof is required only when the worker has reason to believe that the proof provided does not adequately show the family's actual income received or expense paid.

Example 3: Ms. B receives Parent Assist and her children receive KidCare Assist. They also receive food stamp benefits. Item 90 code 802 shows $600. On 01/07/04, she submits mail-in EI REDE Form 4765. She indicates on the form that she is paid weekly. One pay stub dated 12/03/03 showing gross pay of $200 is attached to the form and no changes are anticipated.

The worker sends Form 1721 requesting all pay stubs for the month of December. If Ms. B does not return the remaining pay stubs, deny the FS REDE application. Determine Ms. B's countable income for medical with the one pay stub provided ($200 X 4.3 = $860).

Example 4: Mr. D receives Parent Assist and his children receive KidCare Assist. They also receive food stamp benefits. On 01/07/04, he submits mail-in EI REDE Form 4765. He indicates on the form that he is paid weekly. The four December pay stubs are attached showing that he grosses $300 per week. He indicates on the form that his overtime has ended and he will only be grossing $250 per week. In determining eligibility for medical benefits for December, use $300 per week. In determining eligibility for food stamps and for medical benefits for January and subsequent months, use $250 as the best estimate of weekly pay.

If a TANF family provides sufficient proof of income for medical but not for TANF, the family is no longer eligible for TANF. Take the following action:

  • If countable income is equal to or less than the Family Assist standard, put the case in zero grant using TA 31/TAR 39 and zero grant reason 2.
  • If countable income is greater than the Family Assist standard, and the family has earned income or child support, cancel the case using a Type Action Reason that will authorize extended medical (i.e., 08, 14, 32, 57 or 83).
  • If countable income is greater than the Family Assist standard, and the family does not have earned income or child support, determine eligibility for all Family Health Plans and take the appropriate action.

Example 5: Mr. E receives TANF for his family of 5. At REDE, he provides one pay stub showing that gross income is $100 per week and fails to provide any others. Since countable family income is less than the Family Assist standard, put the case in zero grant using TA 31, TAR 39 and zero grant reason 2.

Example 6: Ms. F receives TANF for her family of 2. At REDE, she provides one pay stub showing that gross income is $200 per week. Since countable income is greater than the Family Assist standard, cancel the case using TAR 14. Ms. F fails to provide the rest of the pay stubs needed for TANF.

[signed copy on file]

CAROL L. ADAMS, Ph.D.
Secretary, Illinois Department of Human Services

BARRY S. MARAM
Director, Department of Public Aid