- Effective January 1, 2014, Illinois will provide medical coverage to persons age 19 through 25 under the Former Foster Care group created by the Affordable Care Act.
- Eligible individuals received foster care services and lost medical coverage when they aged out of (exited) the program at age 18 or older.
- There is no income or resource test for these individuals.
- Eligibility for the Former Foster Care Program
- Exiting Foster Care - Age 18 or Older
- Enrollment into Former Foster Care Medical Benefits
- Transitional Enrollment
- Potential Eligibility for Medicaid
- Action by the All Kids Unit
- Family Health Plans
- Action by the FCRC
- No Evidence of Potential Eligibility for Medicaid
- Self Initiated Applications
- Eligible Category 98 DCFS Case IDs
- Client Data Base, IPACS and ACM
- Retroactive Coverage (Medical Backdate)
Effective January 1, 2014, the Affordable Care Act (ACA) provides medical coverage to individuals who lose medical coverage as a result of aging out of (exiting) foster care at the age of 18 or older. Public Act 98-0104 authorizes the Department to provide medical coverage under the provisions of ACA.
Eligibility for the Former Foster Care Program
The Former Foster Care program covers individuals who received foster care services provided by Illinois Department of Children and Family Services (DCFS). The following individual is eligible:
- Age 19 through 25;
- Does not qualify for medical benefits under Family Health Plans or AABD;
- Received foster care assistance through DCFS until they aged out (exited) at age 18 or older;
- Illinois resident PM 03-02-00;
- Has a Social Security Number (SSN) or proof of application for an SSN PM 03-11-00; and
- Meets U.S. citizenship or immigration requirements in PM 03-01-00.
There is no income limit, and resources (assets) are not considered for this group.
Exiting Foster Care - Age 18 or Older
Individuals who exit foster care at age 18 or later will receive up to 12 months of continuous eligibility beginning with the month they exit foster care until their 19th birthday. Individuals who exit foster care at age 19 or later qualify for Former Foster Care medical benefits until age 26.
Individuals who do not qualify for Former Foster Care medical benefits may still qualify for medical benefits under the new adult group.
Enrollment into Former Foster Care Medical Benefits
Enrollment in the Former Foster Care medical benefits program will come from two sources:
- Transitional enrollment of DCFS Foster Care (category 98) individuals who are losing their foster care coverage and medical benefits due to aging (exiting) out; and
- Self initiated applications from individuals who aged out of (exited) foster care in Illinois prior to 01/01/14 but are not yet age 26.
DCFS will provide a weekly list of individuals aging out of (exiting) foster care services to the All Kids unit.
The All Kids unit will review the list of DCFS individuals and open either a Former Foster Care case or other case as appropriate and route them to the appropriate Family Community Resource Center (FCRC).
The DCFS report will include the following information:
- Recipient Identification Number (RIN);
- Date of birth;
- Social Security Number (SSN);
- Address & phone number;
- Language preference;
- Third Party Liability (TPL);
- DCFS case ID number; and
- Information regarding potential eligibility for Medicaid;
- Individual is pregnant;
- Individual is living with a dependent child; or
- Individual is receiving Supplemental Security Income (SSI).
Potential Eligibility for Medicaid
Action by the All Kids Unit
Family Health Plans
If the individual on the list is potentially eligible for Family Health Plans, send an application to the individual.
If the individual receives SSI, do not send an application.
The All Kids unit will notify the Family Community Resource Center (FCRC) that an SSI recipient who received foster care services is Medicaid eligible. Include in this notification the information provided on the individual in the DCFS report.
Action by the FCRC
Upon receipt of the notification by the All Kids unit of a Medicaid eligible SSI recipient, take the following actions:
- Review the information provided by DCFS on the individual.
- The Social Security Administration has already verified income, resources and citizenship/immigration for an SSI recipient. Check the remaining clearances per PM 02-07-01.
- If appropriate, open an AABD case for the individual. A signed application is not required. Ensure there is no break in medical coverage following the end of the category 98 medical coverage. Leave Item 25 blank.
- Document in the case file that the individual is a Former Foster Care individual who is Medicaid eligible.
Note: A former foster care individual who is Medicaid eligible will not have an identifier on their case showing that they qualify for Former Foster Care. If this individual loses Medicaid due to excess income prior to their 26th birthday, review eligibility for Former Foster Care medical benefits before canceling the Medicaid coverage. Contact HFS policy at 217-557-7158 for guidance.
No Evidence of Potential Eligibility for Medicaid
A signed application is not required.
Using the Worker Portal in the Integrated Eligibility System (IES), open a Former Foster Care case. Ensure there is no break in coverage between the medical coverage under category 98 and Former Foster Care. See System for special coding in Item 25.
Self Initiated Applications
Self initiated applications may arrive through ABE and appear in the EDM or they may arrive as paper applications. The All Kids unit processes both types of applications.
Once the application is registered, IES determines eligibility for Family Health Plans and AABD first. If the individual is not eligible, IES determines eligibility for Former Foster Care or the new adult group.
When these individuals indicate on their applications that they aged out of foster care in Illinois, check MMIS for a category 98 case ID number.
Only individuals who received DCFS foster care services under certain category 98 case ID numbers are eligible for Former Foster Care medical benefits. In MMIS, an eligible category 98 case must be listed in the last eligibility segment before category 98 eligibility ends.
Eligible Category 98 DCFS Case IDs
- Any DCFS district office in Group 01;
- Any DCFS district office in Group 02;
- Any DCFS district office in Group 11;
- Any DCFS district office in Group 20;
- Any DCFS district office in Group 22;
- Any DCFS district office in Group 62;
- Any DCFS district office in Group 13 (except office 313);
- Any DCFS district office in Group 21 (except office 313); and
- Any DCFS district office in Group 61 (except office 313, 613, 618, 713).
If the individual received DCFS services under a category 98 case ID number not listed above, determine eligibility for ACA adult.
Both ABE and the Worker Portal contain a question about foster care assistance.
If an applicant received foster care under an eligible category 98 case number, enter Yes to the foster care question. If the applicant received foster care under a category 98 case number that is not listed as eligible, answer the foster care question No.
For an application to be considered for Former Foster Care assistance, the foster care question must be answered Yes in the Worker Portal. To find the foster care question in the Worker Portal, go to Data Collection/Living Arrangement.
Answering Yes to the foster care question will disregard the income of the applicant.
Note: Until further enhancements are made to IES, a Former Foster Care individual who is not Medicaid eligible will be assigned to an ACA Adult EDG. Former Foster Care eligibility is confirmed by checking the certification screen.
Client Data Base, IPACS and ACM
Answering Yes to the foster care question will populate item 25 with code J. Do not enter code J on a Former Foster Care individual who is eligible for Family Health Plans or AABD. Item 25 coding is used to develop the MANGP code in MMIS.
Retroactive Coverage (Medical Backdate)
Retroactive medical coverage is available per PM 17-02-05 for Former Foster Care medical benefits. The eligibility period may begin no earlier than 01/01/14.
[signed copy on file]
Michelle R.B. Saddler
Secretary, Illinois Department of Human Services
Director, Illinois Department of HealthCare and Family Services