Healthcare and Family ServicesHealthcare and Family Services

10/04/13

Summary

  • Effective October 1, 2013, Family Health Spenddown for adults, AABD, MSP and HBWD cases must be processed in AIS or IPACS.
  • All applications with an application date prior to October 1, 2013 must be processed in AIS.
  • Effective October 1, 2013, process TANF, MAGI Medicaid, and SNAP in IES up through and including "Run Eligibility".
  • Also, on October 1, 2013, certify Mercury issuances on SNAP cases in IES.  IES will prevent caseworkers from certifying MAGI Medicaid, TANF, and regular roll SNAP at this time.
  • When data synchronization between IES and CDB is fully operational, pending cases will be certified. More on that process will be shared later.
  • Applications registered in IES will appear in the CDB. This includes Child Presumptive Eligibility (C-PE).
  • A determination of eligibility for AABD must be made on all applications when an applicant does not qualify for FHP and is age 65 or over, receiving Medicare, SSI, or SSDI or resides in a LTC facility or request in-home waiver support services. Applications that come through ABE that are potentially AABD eligible may be flagged in the IES EDM Inbox under the Special Indicator tab.
  • The All Kids Unit may receive applications potentially eligible for AABD from the Market Place or through ABE. These applications will be sent to the FCRC for processing.
  • Workers must review all applications before registering them in IES. Based on the applicant's responses, determine if the applicant must be reviewed for AABD medical. If potentially eligible for AABD, register the application in AIS.
  • For persons who report to have a disability and do not qualify for FHPs, a CAU determination is needed. Register the person first in ACA Adult, and approve if eligible, while a determination of disability is pending.
  • When customer is approved in AIS, withdraw the application from IES using denial reason, Application Withdrawn (TAR 60). Enter Code 90 to suppress the notice on the Certification Page in IES when customer is approved in AIS.
  • The Client Assessment Unit (CAU) will complete the disability determination on approved ACA Adult cases that are pending an AABD eligibility determination.
  • ACA Adult cases will appear in the Client Data Base (CDB) as a Category 94 case with special coding in Item 25 and Item 28.
  • If a person enrolled in SNAP submits an application for medical benefits under FHP or ACA Adult, the medical application must be processed in IES. The medical and SNAP case will be converted to one IES case in Phase 1B.

  1. IES System
  2. AIS System
  3. Identifying AABD Applications
  4. ACA Adult Cases Pending CAU Decision
  5. Applications Incorrectly Registered in IES
  6. Family Health Spenddown Cases for Adults
  7. Family Health Spenddown Cases for Children
  8. Persons with Active SNAP Who Apply for Medical

IES System

Mercury issuances on SNAP cases can be certified in IES.

IES will prevent caseworkers from certifying MAGI Medicaid, TANF, and regular roll SNAP at this time. The cases will be placed in pending status until data synchronization between IES and the CDB is fully operational. After data synchronization has been verified, pending cases will be certified. More on that process will be shared later.

Applications registered in IES will appear in the CDB. This includes Child Presumptive Eligibility (C-PE).

AIS System

Beginning October 1, 2013, the Automated Intake System (AIS) will remain available for processing certain cases. The following cases must be processed through AIS or IPACS:

  • AABD;
  • AABD cases with SNAP;
  • MSP; and
  • HBWD (processed by HFS Central Office only)
  • Family Health Spenddown for adults.

Do not register these applications in IES. The workers must open and view the application from the IES Inbox and process in AIS or IPACS. The FCRCs will process all AABD, and MSP only applications.

Caseworkers must review all paper and IES applications requesting medical benefits before registering them. Review the PDF version of the application to identify if the application is most likely a Family Health Plan, AABD or ACA Adult case. Use the following priority list to determine if the adult should be registered in AIS or IES:

1. First, review eligibility for Family Health Plans (FHP), including Moms and Babies. See PM 04-02-00. Register the application in IES if the adult(s) is potentially FHP eligible.

2. If there does not appear to be FHP eligibility for the adults, review the applicant's responses and determine if the applicant is potentially eligible for AABD medical.  If potentially eligible for AABD, register and process the application in AIS . If the application was received through ABE, reference the 'T' number from the IES application on the AIS write up page since the original application will be stored in Content Manager under that number.

3. If the applicant is not potentially eligible for FHP or AABD, register and process the application as an ACA Adult 94 case in IES.

Adult Family Health Spenddown cases will be processed in AIS, also. In IES, these adults will be denied due to income and referred to the Marketplace, but should be reviewed for FHP spenddown if medical expenses are provided. These cases may be processed by the FCRC or the All Kids Unit.

All applications received prior to October 1, 2013 must also be processed in AIS or IPACS.

Identifying AABD Applications

The FCRC/All Kids caseworker will review applications in the IES EDM Inbox to identify and select persons who are not FHP eligible but may be AABD eligible. A special indicator in the EDM Inbox may help to identify when an applicant is:

  • age 65 or older;
  • receiving Medicare; or
  • receiving LTC services (nursing homes, SLF or HCBS).

If any of these factors are present or other information on the application indicates a person may be eligible for AABD, the FCRC will open the PDF application from the EDM Inbox and register the application in AIS as a 91, 92, or 93 case. Reference the 'T' number from the IES application on the write up page in AIS. This will link the AIS application to the IES application which will be stored in Content Manager. After case has been approved in AIS, register and deny the application in IES using TAR 60 and suppress the client notice.

ACA Adult Cases Pending CAU Decision

Review those applicants:

  • who declare to have a disability or
  • who are in need of help with activities of daily living, but do not receive SSI or SSDI.

When a person applies for medical benefits and report they have a disability but have no proof of disability, the caseworker will:

  • Register and approve applicant in ACA Adult category '94' case, if eligible, while CAU is pending.
    • Item 25 is coded K; and
    • Item 28 is coded W (adult only)
  • If income ineligible for ACA Adult, the application will be automatically referred to the Marketplace
  • Send Instructions to Client (Form 267) requesting verifications for individuals who apply for AABD.
  • Complete and send CAU packet. Review WAG 03-08-01. Mark the "ACA Adult" box or write "ACA Adult" on Medical Evaluation (Form 183F) to indicate that the case is an ACA Adult case.

If CAU determines the applicant has a qualifying disability and all other factors of eligibility are met, register and approve the AABD case in AIS as a '93' case. Dates of coverage are established per current policy. Cancel the ACA Adult case.

If CAU determines the client meets the disability requirement but the client is eligible with a spenddown, contact HFS Policy about the case using Form 2150 Request for Specific Case Guidance. If CAU determines that the applicant is not disabled, no action is required on the ACA Adult case.

Applications Incorrectly Registered in IES

Prior to data collection, withdraw applications that are registered in IES in error when applicant is potentially eligible for AABD. Use TAR 60 and suppress the notice. This is done on the Certification Page.

After data collection has been initiated, if an AABD EDG is created for a person who appears eligible for AABD, deny the AABD EDG with TAR 60 and suppress the notice. For applications received by the Bureau of All Kids, send the application to the FCRC for processing. Case will appear on the pending list in the FCRC.

Family Health Spenddown Cases for Adults

Beginning October 1, 2013, Adult Family Health Spenddown must be processed in AIS. When it is discovered that the parent (s) are eligible with a spenddown, process the adult spenddown case if the applicant provides medical expenses. These cases may be processed by the FCRC or the All Kids Unit.

Family Health Spenddown Cases for Children

Spenddown for children can be processed in IES. The parent will be changed to "non-requestor" on the All Kids case. Determine medical eligibility for the child(ren) only in IES.

If there are medical expenses submitted to meet spenddown, spenddown is authorized for backdated months. Medical will be approved for Share/Premium for the regular roll month and on-going, if eligible. These cases may be processed by the FCRC or the All Kids Unit.

Persons with Active SNAP Who Apply for Medical

When a person with an active SNAP case applies for medical benefits and is eligible for medical under FHP or ACA Adult, process the case for medical eligibility in IES. Two cases will exist until phase 1B of IES is deployed early in 2014. The SNAP case may remain active but must be reviewed for possible changes based on the information reported on the medical application.

The office that receives the medical application will process the application and must notify the Local Office Administrator of the FCRC maintaining the SNAP case by email when the medical application is received in a different location. The subject line for this email should read "REVIEW SNAP CASE, ADDED MEDICAL". The email will include the IES case number and legacy caseload number for the SNAP case.

[signed copy on file]

Michelle R. B. Saddler

Secretary, Illinois Department of Human Services

Julie Hamos

Director, Healthcare and Family Services

Forms referenced:

Form 183F

Form 267

Form 2150