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07/05/07

Summary:

  • Effective 05/01/07, an Illinois Healthy Women (IHW) Expansion allows women age 19 through 44 to apply for family planning (birth control) services.
  • The All Kids Unit will process IHW expansion applications and maintain cases.
  • System changes are listed.
  • New denial Type Action Reasons (TARs) are introduced.
  • New TARs under which a woman can be auto-enrolled for Illinois Healthy Women are added.

  1. Office Responsibility for Eligibility and Case Maintenance
  2. Application Process
  3. Eligibility
    1. Verification Required at Application
      1. Income
      2. U.S. Citizenship and Immigration Status
      3. Social Security Number
  4. Covered Services
  5. Health Insurance
  6. Systems Changes
    1. Item 80 Family Planning Codes
      1. Code 378 Family Planning Expansion
      2. Code 379 Family Planning
    2. Authorizing Coverage
    3. MANGP Codes
    4. Denial Type Action Reasons (TARs)
  7. Changes
  8. Renewals
  9. Additional Type Action Reasons for Auto-Enrollment
  10. Examples

This Policy Memorandum was prepared by Healthcare and Family Services (HFS). HFS administers the Medicaid and All Kids programs. These programs provide medical benefits to families with children and to other persons. This information is to be used by staff of the central All Kids and Health Benefits for Worker's with Disabilities (HBWD) Units and the Illinois Department of Human Services when determining eligibility and authorizing medical benefits.

Effective 05/01/07, HFS expanded the Illinois Healthy Women program to allow women to apply for family planning services only. 

Women who qualify for Illinois Healthy Women when their medical eligibility ends will continue to be auto-enrolled in Illinois Healthy Women as described in Policy Memorandum Illinois Healthy Women dated 04/05/04.

Women whose Illinois Healthy Women applications are approved will receive an Illinois Healthy Women Questions & Answers Fact Sheet Form 3711HW/S (pdf) and a pink identification card called the Illinois Healthy Women Card (Form 469HW) which is valid for 12 months.

Office Responsibility for Eligibility and Case Maintenance

The central All Kids Unit will process Illinois Healthy Women applications and maintain the newly approved cases as well as continue maintaining the auto-enrolled cases.

DHS Family Community Resource Centers (FCRCs) caseworkers should refer Illinois Healthy Women customers to the All Kids unit at 1-877-805-5312 for questions about Illinois Healthy Women, replacement of pink medical cards, and other case maintenance issues. 

If a woman states she would like to apply for Illinois Healthy Women, give her Form 2378HW Application for Illinois Healthy Women (pdf) or Form 2378HWS (pdf). Refer her to a local family planning clinic for assistance with the application and family planning services. 

Application Process

To apply for Illinois Healthy Women, women must complete and submit a Form 2378HW or 2378HWS Application for Illinois Healthy Women to the All Kids Unit.

Eligibility

To be eligible for the Illinois Healthy Women program, a woman must: 

  • be at least age 19 and younger than age 45;
  • have income at or below 200% of the Federal Poverty Level;
  • not be pregnant;
  • not be sterilized;
  • is not receiving medical benefits through HFS or DHS;
  • meet citizenship/immigration requirements as described in PM 03-01-02 and in Policy Memorandum U.S. Citizenship and Identity for Medical Programs;
  • provide a Social Security Number or proof of application for one; and
  • be an Illinois resident as described in PM 03-02-01

Men are not eligible for this program.

If eligible, the first date of eligibility is the first day of the month the application is received. Eligibility continues for 12 months or until the woman turns age 45.

Refer women who are ineligible noncitizens to the Department of Human Services Helpline at 1-800-843-6154 (TTY 1-800-447-6404) to get information about family planning services.

Verification Required at Application

Age and SSN can be verified through the State Online Query (SOLQ) system.  Except as stated below, accept the applicant's statement on all other eligibility factors unless there is conflicting information.

Income

The applicant's income must be verified.  One paystub or proof of one payment from each source of income is sufficient to verify income.  Refer to Action Memorandum Verifying Income-Family Health Plans dated 12/23/03 for more information.

U.S. Citizenship and Immigration Status

Request U.S. citizenship documentation if it is not provided with the application.  At this time, do not deny the application if the applicant fails to comply with the citizenship and identity documentation requirements.  Refer to Policy Memorandum U.S. Citizenship and Identity for Medical Programs dated 07/01/06 for more information.

Immigration status must be verified at application. Refer to PM 03-01 for more information. 

Social Security Number

Applicants for IHW must either have a Social Security Number (SSN) or proof of application for an SSN. 

Covered Services

The Illinois Healthy Women card covers the following services:

  • Physical exam and health history for family planning purposes;
  • Office visits related to family planning;
  • Pap tests;
  • Necessary family planning or women's health related lab and diagnostic tests;
  • Birth control drugs and devices including the inserting, implanting, or injecting of a birth control drug, and removing a birth control device;
  • Sterilization services;
  • Testing for sexually transmitted infections, including HIV, if diagnosed during a family planning visit;
  • Medicine for sexually transmitted infections (except HIV) if diagnosed during a family planning visit;
  • Mammograms as medically indicated and ordered at the family planning visit; and
  • Generic prenatal vitamins or generic multivitamins with folic acid.

Health Insurance

Complete Form 1442 Third Party Liability Report for applicants who report having health insurance that covers birth control.  Enter the appropriate code in Item 79. 

Systems Changes

Item 80 Family Planning Codes

Item 80 Family Planning codes 378 and 379 are centrally entered.  Once code 378 is entered on a case, it cannot be changed to a 379 code. However, once a woman's coverage lapses, tracking for Family Planning ends.  If the woman is auto-enrolled in IHW or becomes eligible through the application process, the appropriate Item 80 code is centrally entered on the 190 case.

Code 378 Family Planning Expansion

A new Item 80 code 378 FPX is centrally entered on all 190 cases opened in IPACS.  These cases receive 12 months of eligibility.

The PERSONS field tracks each year the woman participates in IHW.  Upon approval, the system enters 01 in the PERSONS field which indicates the first year of coverage.  When the renewal is processed, the counter advances by 1 to count each subsequent year of coverage. 

The SBY field contains either codes Y, N, or S.  Code Y generates the Illinois Healthy Women Re-Enrollment Form 3815A when the woman reaches the 10th month of eligibility since the application or last review. Codes N and S suppress the mailing of future re-enrollment forms.  The system centrally enters N when the woman is approved for other medical benefits.

Item 80
Code Amount Persons Total Cost SBY
378 - 01 - Y

Code 379 Family Planning

Item 80 code 379 FPW will continue to appear on all auto-enrolled IHW cases. 

Authorizing Coverage

Use IPACS to approve or change Illinois Healthy Women cases.  All Illinois Healthy Women cases are in office 190.

If the applicant previously received Illinois Healthy Women, check the applicant's Recipient Identification Number in MMIS. If the Illinois Healthy Women coverage has expired, process the IHW application.

The central All Kids Unit:

  • registers the application in IPACS,
  • denies the application; or
  • enters the following Items on Form 552.
IPACS Coding
Item # Description Entry
1 Basic Number Reuse an existing Basic Number if  available
2 Effective Date Per Authorization Schedule
3 Type Action 10
5 Caseload Number As instructed
8-10 Name and Address Per WAG 27-08-00 through WAG 27-10-00
20 Household Arrangement 16
21 Language Indicator 01 or 04
22 Number Living Together Per Application
33 Type Action Reason F2
53 True County of Residence Per WAG 27-53-00
59 Phone Number Per Application
60 Name, RIN, SSN, Alien Registration Number Per Application
61 Birthdate Per Application
62 Relationship 02
66 Sex 2
69 Match 1
70 Veteran Status 1
73 WT Health Condition 1
74 Citizenship/Immigration Code Per Policy Memo on citizenship dated 7/1/06 or PM 03-01
77 Last Beginning Eligibility Date 1st day of the month of the date the application is received
79 TPL Per Application
80 Needs/Race-Ethnicity Per MR #07.07 Racial Ethnic Coding
90 Income Per Application

The turnaround action will show a TA 28, TAR F2 the next day in ACID.  There is no countable income code in Item 80 for 190 cases.

MANGP Codes

Two new MANGP codes FW or FX will appear in the Recipient Database (RDB) under the Family Planning Eligibility segment for each woman approved for IHW through the application process.

  • MANGP code FW will appear for uninsured women;
  • MANGP code FX will appear for insured women; and
  • MANGP code FP will continue to appear for women who are auto-enrolled in IHW following the end of their medical benefits.

Insurance status of women who are auto-enrolled in IHW is not tracked by MANGP code.

Denial Type Action Reasons (TARs)

The new denial TARs listed below will generate a central notice.  For all other denials, use the existing TARs in WAG 27-33-01-q.

Denial Type Action Reasons (TARs)
TAR Reason Message
F3 Does not meet immigration requirements You must meet citizenship or immigration requirements to qualify for Illinois Healthy Women. You may qualify for low cost family planning and related reproductive health services through another program. Please contact the Department Human Services Help Line at 1-800-843-6154 (TTY: 1-800-447-6404), select language, and choose option #5, WIC & Other Health and Prevention Services, to learn more about family planning resources and low cost providers in your area. Many of those providers charge a sliding fee, depending on your income. PM 03-01
F4 Income exceeds 200% of the FPL Your income is more than the limit for Illinois Healthy Women. You may qualify for low cost family planning and related reproductive health services through another program. Please contact the Department Human Services Help Line at 1-800-843-6154 (TTY: 1-800-447-6404), select language, and choose option #5, WIC & Other Health and Prevention Services, to learn more about family planning resources and low cost providers in your area. Many of those providers charge a sliding fee, depending on your income. Policy Memorandum dated 07/05/07
F5 Applicant is pregnant You are pregnant. You may qualify for full healthcare benefits under Moms & Babies. You can get a Moms & Babies application by calling toll free 1-800-226-0768 or go to www.allkids.com to apply online. If you use a TTY, call 1-877-204-1012. Policy Memorandum dated 07/05/07
F6 Applicant is sterilized Our records show that you have had a surgical sterilization procedure. Policy Memorandum dated 07/05/07
F7 Applicant must be a woman age 19 through 44 You must be a woman age 19 through age 44 to qualify for Illinois Healthy Women. Policy Memorandum dated 07/05/07

Changes

The following changes may be made on a 190 IHW case using TA 39, TAR 40.

  • Change of address;
  • Change of case name or DOB; and
  • Change Item 80 code 378 FPX SUPBY indicator.

If a woman reports that she is pregnant or no longer wishes to participate in IHW, change the Item 80 code 378 FPX indicator from Y to N.  Entry of N suppresses the central mailing of the next Form 3815A.

If a woman reports that she has been sterilized, enter code S in the SUPBY field to suppress the central mailing of the next Form 3815A. 

A woman is sterilized if she reports she had a tubal ligation (had her "tubes tied"), tubal sterilization, or a total hysterectomy.  A woman who has a hysterectomy is sterilized.  Hysterectomy is not a covered service through IHW.

Renewals

Women must renew their Illinois Healthy Women card once every 12 months.  An Illinois Healthy Woman Re-Enrollment Form 3815A and a 3815B Calculation Sheet are sent centrally with a self addressed stamped return envelope in the 10th month of eligibility.

Accept the woman's statement regarding her monthly income statement on the Re-Enrollment form. 

If the woman is determined eligible, process the renewal by entering TA 10, TAR C4.  This transaction advances the counter in the Item 80 code 378, authorizes 12 more months of eligibility, and generates a new pink Illinois Healthy Women ID card Form 469HW.

Additional Type Action Reasons for Auto-Enrollment

Women who lose medical benefits due to failure to cooperate with child support or medical support rights will now be auto-enrolled in IHW. These TARs are listed below.

  • Deletion TARs for category 94/96: 02 and 20
  • Deletion TAR for category 04/06: 02
  • Cancellation TARs for category 94/96: 50, 56, and 94 
  • Cancellation TARs for category 04/06:  16 and 94
  • Cancellation TARs for category 92/93:  50 and 56.

Examples

Example 1: Ms. A's application for IHW is dated 4/5/07.  Ms. A meets all of the eligibility factors.

Central All Kids Unit: 

  • Registers the application in IPACS;
  • Reviews the application and determines that Ms. A is eligible for IHW;
  • Approves the application in IPACS using TA 10, TAR F2.

The System:

  • Calculates the end date in Item 41 to be 12 months from the start date of benefits;
  • Enters the Item 80 code 378 FPX and sets the counter to 01, Y;
  • Shows a close out in ACID TA 28, TAR F2;
  • Sends a record to MMIS showing 12 months of eligibility for Ms. A in the Illinois Healthy Women segment; and
  • Sends a central 360HW approval notice. 

Example 2: Ms. B's application for IHW is dated 4/16/07.  In a phone conversation, the caseworker learns that Ms. B had a tubal ligation. 

Central All Kids unit:

  • Registers the application
  • Denies the application in IPACS using TA 05, TAR F6

The System:

  • Processes the denial action
  • Sends a central 360HW denial notice

Example 3:

Ms. C was approved for IHW in May 2007.  Three months later, she calls to report that she moved to Missouri.

Central All Kids Unit:

  • Changes the address in IPACS using TA 39, TAR 40 and updates the indicator in Item 80 code 378 from Y to N

The System:

  • Processes the address change
  • Suppresses the centrally generated Re-Enrollment Form 3815A

[signed copy on file]

CAROL L. ADAMS, Ph.D.

Secretary, Illinois Department of Human Services

BARRY S. MARAM

Director, Healthcare and Family Services

Forms referenced:

HFS Form 469HW

HFS Form 2378HW (pdf)

HFS Form 2378HWS (pdf)

HFS Form 3711HW/S (pdf)

HFS Form 3814

HFS Form 3815A