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08/13/13

The CountyCare demonstration program is operated under a special waiver approved by the Centers for Medicare and Medicaid Services.  Some of the policy described in this memorandum applies only to CountyCare and may vary from policy described in other sources.

U.S. Citizenship

For applicants who state they are U.S. citizens, use the procedures in PM 03-01-01-b and WAG 22-14-03-e to verify citizenship and identity through Social Security Administration's WTPY system. Always check electronic sources for verification before asking the applicant to send documents.

If the WTPY inquiry does not verify U.S. citizenship, send Form 267 and Form 3859A Help Sheet for Citizenship & Identity Documentation and give them 3 months to provide the documentation. Important: if the applicant is otherwise eligible for CountyCare, approve the application and set a control for 90 days for follow up. Do not delay approval for CountyCare while waiting for proof of U.S. citizenship. Federal regulations require allowing the applicant 90 days to provide the verification.

Verification of Incarceration Form

When WTPY fails to establish citizenship, the Verification of Incarceration form provided by Cook County Department of Corrections is a valid document to verifiy identity.  Send Form 267 the applicant to request proof of citizenship as described in WAG 03-01-01-b.

The form must include the signature and printed name of a Cook County Department of Corrections official.

Cook County Vital Records

Electronic birth records from Cook County Vital Records are acceptable evidence of U.S. birth at the secondary level. See WAG 03-01-01-b.

Income Verification

Applications submitted to the Stroger Family Community Resource Center (FCRC) for CountyCare may contain proof of income that is older than 30 days if the proof meets the following conditions:

  • The proof of income is for a 30 day period;
  • The 30 day period falls within the three months prior to the month of application;
  • There is no reason to believe the amount of income is incorrect; and
  • The proof of income is reasonably compatible with income expected to be received for the first regular roll month of coverage.

For more information, see policy memorandum dated 3/8/13 Applications for Countycare

Electronic Sources of Income

In an effort to reduce delays in submitting applications for CountyCare, the application assistors for CountyCare will not request proof of income from the applicant for those reporting Social Security income or Illinois unemployment income.

Effective immediately, when an applicant reports Social Security income and/or Illinois unemployment income, verify Social Security income using SOLQ and Illinois unemployment income using AWVS.

Retroactive Coverage

Backdate coverage for each month that meets the eligibility criteria, unless the applicant indicates they do not want to backdate. For CountyCare, authorize the 3 month backdate, if eligible, when the applicant fails to specify the backdate months requested PM 17-02-05-a.  If the applicant indicates they want a backdate and specify fewer than three months, authorize the months they specify. Backdated coverage cannot skip months.

If income in the backdate months is believed to be consistent with the verified income, additional proof of income for each backdate month is not needed to authorize the backdate coverage. The income is consistent if:

  • It's from the same source;
  • It's clear the income is not from a brand new job (YTD=current gross); and
  • The income is at or below 133% of the FPL.

If the verified income is not believed to be consistent with the back date months, verification of a full 30 days of income is needed for each month for which the income is inconsistent. Treat the income as consistent unless the worker has specific knowledge that the income is inconsistent.

Example 1: Mr. K applies for CountyCare 4/2/13. He provides 30 days' worth of paystubs for March. Based on information provided, it appears there is no evidence that the income was different in the backdated months. Authorize the backdate for January, February and March.

Example 2: Ms. L applies for CountyCare 4/2/13 and answers Yes to the backdate question.  However, she does not list the months of backdate requested.  It appears there is no evidence that the verified income was different in the backdated months.  Authorize the backdate for January, February and March.

Example 3: Mr. M applies for CountyCare 4/2/13 and requests for backdate coverage for March. It appears there is no evidence that the verified income was different in March.  Authorize the backdate for March only.

Example 4: Ms. N applies for CountyCare 4/2/13 and answers Yes to the backdate question for February. It appears there is no evidence that the verified income was different for February or March.  Authorize the backdate beginning February which will include March also.

Example 5:  Mr. O applies for CountyCare 4/2/13 and answers No to the backdate question. Do not authorize any backdated coverage.

Residency

Illinois Residency

To verify Illinois residency, an automated clearance is run for each applicant through the Secretary of State (SoS) system. When the clearance indicates the applicant is an Illinois resident, accept it as verified.

When the SoS clearance indicates there is no information available, the address used in an applicant's medical record or other verification listed in WAG 03-02-00 may be used to establish Illinois residency.

Verification of Incarceration Form

The Verification of Incarceration form provided by Cook County Department of Corrections is a valid document to verify residency when an Illinois address other than the address of the jail is listed.  Consider the address on the Verification of Incarceration form to be more current than results from the Secretary of State residency match.

The form must include the signature and printed name of a Cook County Department of Corrections official.

Cook County Residency

Application assistors verify Cook County residency for CountyCare applicants; therefore, Stroger FCRC staff do not verify Cook County residence on an application. However, if the individual reports an address change, determine whether the new address is in Cook County. Accept the client's statement regarding their address unless there conflicting information.

Applicant Determined Disabled

When an applicant is determined disabled by the Social Security Administration prior to disposition of the CountyCare application, do not require a new application for AABD.  Send a Form 267 to request proof of resources.  Deny the CountyCare application with TAR G6 and reregister the application for AABD.

Third Party Liability (TPL)

Accept the applicant's statement for any health insurance they report. The application assistors will attempt to provide as much TPL information as possible. Do not request a copy of the insurance ID card. Do not delay processing the application while waiting for TPL information. If additional TPL information is received after the application is processed, complete Form 1442 Health Insurance Report and submit it to the TPL unit. The HFS TPL unit verifies health insurance after the case is approved.

Coordination of CountyCare with Other Coverage

Applicants for CountyCare may have other coverage in MMIS. The table below shows other coverage the CountyCare applicant may have and whether or not they can get CountyCare coverage at the same time.

Segment Heading-Eligibility Medical Coverage CountyCare Eligible
Regular Full coverage No
--Regular (LO 195-IDOC) Limited coverage-inpatient only No
--Regular AABD Spenddown* None until spenddown is met Yes-cancel AABD case before opening CountyCare case
--Regular QMB/SLIB/QI-1 only

QMB-Limited

SLIB/QI-1-None

No
Special Program (MPE) Limited coverage-ambulatory only** No
Department of Corrections LO 195 (MANGP code IF) None No
Presumptive/Temporary Medical Benefits Full coverage No
SMIB/HIB (Medicare) None No
DHS Social Services None Yes
HFS Social Services Limited Yes-it's ok to overlap eligibility dates
Family Planning (IHW) Limited Yes-it's ok to overlap eligibility dates

*Clients may choose between AABD spenddown and CountyCare as long as the income as at or below 133% FPL. 

**Ambulatory care does not include inpatient hospitalization or the delivery of the baby.

[signed copy on file]

Michelle R.B. Saddler

Secretary, Illinois Department of Human Services

Julie Hamos

Director, Illinois Department of Healthcare and Family Services

Forms

Form 267

Form 1442

Form 3859A