03/13/13
Summary:
This Action Memorandum follows the increase in the medical program income standards for 2013 and details the central conversions of certain Family Health Plans (FHP) cases as a result of the increase in the income standards for 2013.
Central Conversion of FHP Spenddown to Coverage
Family Health Spenddown cases that no longer have a spenddown due to the increase in the monthly income standards for 2013 will be centrally converted to Assist coverage effective 04/13. Only cases that have been opened or REDEd within the last 12 months will be centrally converted.
For each person age 19 or older with income equal to or less than the new Assist standard, Code A is entered in Item 78. If there is an entry in Item 79 with an alpha code A through E, Code 1 is entered in Item 68. When the entire case is converted, item 80 code 390 SPD will be centrally deleted. If present, Code 396 END SPD is also deleted.
For each person under age 19 with income equal to or less than the new Assist standard, Code R is entered in Item 78.
CN 13.04 (pdf)/CN 13.04S (pdf) is being sent to all cases where at least one person is centrally converted the week of 03/14/13. A one time Mobius report will be generated listing the cases that were centrally converted from spenddown to Assist. The report will be sorted by FCRC and caseload. Look for reports #84505183 Person in Spenddown Converted to FamilyCare Assist or #84505184 for the statewide summary.
Central Conversion of All Kids Premium Cases
All Kids Premium Level 1 cases that qualify for Share due to the increase in the monthly income standards for 2013 will be centrally converted to Share coverage effective 04/13. Item 80 code 192 PREM wil be centally deleted, Item 73 will be updated from Z to Y or L to J and the program name display in ACID will be centrally updated.
All Kids Premium Level 2 cases that qualify for Premium Level 1 due to the increase in the monthly income standards for 2013 will be centrally converted to Premium Level 1 effective 04/13. Item 80 Code 192 PREM and the program name display in ACID will be centrally updated.
CN 13.05/CN 13.05S (pdf) is being sent to all cases where at least one person is centrally converted the week of 03/14/13. A one time Mobius report will be generated listing the cases that were centrally converted from Premium Level 1 or 2 to Premium Level 1 or Share. The report will be sorted by FCRC and caseload. Look for reports #84505273 Central Conversion of All Kids Premium Cases or #84505274 for the statewide summary.
Review of Cases Potentially Eligible for Assist
During the week of 03/14/13, a one time Mobius report will be generated listing the All Kids cases that may qualify for Assist due to the increase in the monthly income standards. Offices that have cases appearing on this list are to review the Share case for Assist eligibility. If eligible, cancel the Share case then open an Assist case.
Note: Although Share cases are maintained in the All Kids Unit (LO 180), this report may contain DHS FCRC cases which have not yet been transferred to LO 180. Look for report #84505281, Potentially Assist Eligible All Kids Share Cases.
[signed copy on file]
Michelle R. B. Saddler
Secretary, Illinois Department of Human Services
Julie Hamos
Director, Illinois Department of Healthcare and Family Services
