Changes to the Illinois Medicaid Redetermination Project (IMRP) revised

Helping Families. Supporting Communities. Empowering Individuals.

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02/06/14

This release updates the Policy Memo Illinois Redetermination Project dated 2/13/13.

Summary:

  • State staff will only be able to use IntegriMatch information through 2/28/14;
  • A new system, Max-IL, will replace IntegriMatch beginning 2/1/14;
  • New central DHS rede units at Hunter and Broadway will process most medical-only redes;
  • Redes for cases with SNAP or cash will continue to be processed by the DHS Family Community Resource Center (FCRC);
  • Maximus will send the rede form to customers who do not receive Cash or SNAP;
  • Customers must complete and return the rede form to Maximus;
  • Max-IL will collect data from electronic sources of information about the case and make an automated recommendation about ongoing eligibility;
  • Rede forms will also be sent to customers losing FHP eligibility due to a child turning 18 or 19, ACA Adults turning age 65, ACA Adults who begin receiving Medicare, Former Foster Care young adults turning age 26 and Refugee/Repatriate Cases at the 8th month after U.S. entry;
  • Additional guidance will be issued about processing MAGI cases in the Automated Case Management (ACM) system.
  1. Max-IL
  2. Max-IL Recommendations
  3. Central Rede Units
  4. Rede Forms
  5. Case Reinstatements
  6. FCRC Redes and Case Reviews
  7. Additional Eligibility Reviews
  8. AABD Resource Verification
  9. Reporting the Rede

Maximus Eligibility Specialists will no longer make recommendations on FHP cases after 12/31/13 and on AABD cases after 1/31/14. State workers will continue to review cases in IntegriMatch and complete redeterminations in ACM through 2/28/14.

Beginning 2/1/14, a new IMRP process will begin. Maximus has developed a new redetermination system called Max-IL to record and store redetermination information for medical-only cases. This process does not apply to cases with SNAP or cash benefits. Redes for cases with Cash or SNAP will still be handled by the FCRC.

Training for staff who will be using Max-IL began about 1/20/14. Maximus will continue to datamatch cases, mail rede forms, electronically store the rede form and customer verifications and provide the information through Max-IL to the state. Maximus will also have Call Center Representatives who will proactively contact the customer to increase the number of returned redes and answer customer questions. Call Center Representatives will record customer contacts and make notes in Max-IL of any information received by phone from the customer.

Max-IL

Max-IL will store copies of all rede forms mailed to the customer, returned redes, electronic datamatching results, requests for missing information and verifications provided by the client. Electronic copies of all forms sent to the customer and verifications provided by the customer will be uploaded to Content Manager. Maximus will:

  • Mail the correct rede form based on the current medical program;
  • Resend the rede form when it is retuned by the U.S. Postal Service with a new in-state address;
  • Record when the form is returned with an out-of-state address;
  • Pre-populate the rede form with information already known about the case;
  • Control the due date for rede forms to be returned;
  • Make automated recommendations based on electronic information available about the individuals in the case; and
  • Store electronic copies of forms and notices mailed, forms and proofs returned and electronic datamatching results.

Max-IL will generate a task to the central rede unit worker when:

  • The rede form is not returned by the due date;
  • The rede form is returned;
  • The Missing Information form is generated to request additional information and is not returned by the due date;
  • The Missing Information form is returned;
  • Late information is returned after the rede is processed. The late information task allows the rede worker to determine whether the new information would allow the canceled case to be reinstated.

Max-IL Recommendations

Based on electronic datamatching, the Max-Il system will make an automated recommendation about the case's on-going eligibility. Max-IL will review sources that report deaths, out of state residence and income to make a recommendation about the case. These recommendations will be:

  • Case Likely to be Ineligible - when electronic information identifies the client is deceased, the household has moved out of state, or countable income exceeds income standards;
  • Case Likely to be Eligible - when electronic information verifies current ongoing income eligibility and all factors of eligibility appear to be met;
  • Cases Likely to Require a Change - when electronic information identifies a change needed to the number of members in the household due to a death of one member, one member moves out of state, or identified income would change the type of program the household should receive;
  • Insufficient Information to Make a Recommendation - when electronic information available about the household does not clearly identify ongoing eligibility, ineligibility or a necessary change.

State casework staff are responsible for making the eligibility decision on the case and processing changes in ACM or IPACS.

Central Rede Units

New central rede units will handle most medical-only redeterminations as follows:

  • All Kids Share and Premium redes will be handled by the HFS Bureau of All Kids (BAK);
  • Other FHP redes will be handled by the Hunter and Broadway Rede Units;
  • Community AABD, Department on Aging) Community Care and Medicare Savings Program redes will also be handled by Broadway and Hunter;
  • Medical Extension cases will continue to be handled by the Medical Extension Unit (MEU);
  • ACA Adult, Former Foster Care and Refugee cases will be handled by Broadway and Hunter;
  • Nursing Home (NH) and Supportive Living Program (SLP) redes for Regions 1 and 2 will be handled by Medical Field Operations (MFO) and by the Macon LTC Unit for Regions 3, and 5. Region 4 offices will continue to process LTC redes in the FCRC and will use Max-IL to review and report LTC medical-only redes.

The central unit will be responsible for all changes reported as part of the rede process. Changes that are reported or discovered that are not part of the rede process are handled by the office responsible for that case and are not referred to one of the central rede units.

If information for a rede that is handled by one of these central rede units is sent to the incorrect office, immediately forward the information to Maximus by:

All rede-related information about the case will be returned to Maximus and electronically stored in Max-IL so that the central rede unit can make a determination of ongoing eligibility. If rede forms or verifications for a rede are received by the FCRC or BAK, immediately fax or scan and email the documents to Maximus. If original copies of citizenship verification are received at the FCRC or BAK for a rede, continue to follow the instructions in Action Memo: Citizenship Verification Requirement at Redetermination dated 9/9/13.

Rede Forms

Two months before the rede is due, Maximus will pre-populate the correct redetermination form for medical only cases. FHP, ACA Adult and Former Foster Care cases will be sent a MAGI pre-populated rede form. AABD, DoA and MSP cases will be sent a non-MAGI pre-populated rede form. Nursing home and SLP cases will continue to receive the Form 1229A.

The MAGI and non-MAGI pre-populated rede forms will contain information that is currently in the case file (CDB). The state is working with Maximus to identify electronic sources that are reliable and current and can be used to pre-populate the form with additional information.

Customers must complete the rede form by confirming that the information (household members, income sources and amounts, resources for AABD cases) is correct or write in the correct information. The customer must include proof of any new information reported if proof is required to determine eligibility. Do not require proof for any information that can be obtained electronically (for example, earned income that is available though The Work Number or AWVS, Social Security benefits, or proof of citizenship available through WTPY). Do not cancel the case if the form is complete but not signed.

The central rede unit will send a Missing Information request form through Max-IL when new information reported on the rede form must be verified or when the rede unit has questions about the customer's situation as a result of the rede form. The Missing Information form will also be returned to Maximus and stored in Max-IL so that all information related to rede is together.

Case Reinstatements

If a case has been canceled due to non-cooperation by the Broadway or Hunter central rede units, it will be reinstated by the same office if the customer cooperates by the end of the last day of the month after cancelation and remains eligible per PM 19-04-02. If the customer cooperates by providing information to the local FCRC during the period when the case can be reinstated, the FCRC will fax or scan and email the information to Maximus. Maximus will enter the information into Max-IL which will create a task for the Broadway/Hunter unit to review.

If the customer cooperates after the reinstatment period, the FCRC will reopen the case after reviewing the information provided in Max-IL and the new information provided by the client. Max-IL documents are uploaded to Content Manager and can be viewed by the FCRC. If the FCRC needs to view Max-IL case notes or other information, designated regional staff have access to the Max-IL system.

FCRC Redes and Case Reviews

Other redes will continue to be handled by the offices currently responsible for the case. FCRCs will continue to process medical redes for cases with SNAP and cash. Rede forms for SNAP cases with medical are being revised to include MAGI questions. Until those are received by the FCRC, continue to use Relationship Rules to determine eligibility for MAGI cases if the income tax filing status is unknown.

FCRCs will also be responsible for:

  • completing Priority Action List (PAL) code reviews or other central crossmatches on their cases,
  • changes reported after the rede is completed by the Broadway or Hunter office, and
  •  reopening a case that has been canceled by the Broadway or Hunter rede units after the reinstatement period if the client provides proof of ongoing eligibility.

Additional Eligibility Reviews

Maximus will also send redetermination forms to the following groups and print a special message on the rede form when the current eligibility is about to change:

  • Young adults on FHP cases turning age 19 in the intervening month (i.e., March birthdays so that action can be taken for April in a new program, if eligible) will receive the MAGI rede to determine ongoing ACA Adult eligibility.
    • Special Message: Our records indicate you are turning age 19. So that we can determine if you are eligible for another medical program, you must complete and sign this form.
  • Young adults on Former Foster Care cases turning age 26 in the intervening month will receive the MAGI rede to determine ongoing ACA adult eligibility.
    • Special Message: Our records indicate you are turning age 26. So that we can determine if you are eligible for another medical program, you must complete and sign this form.
  • Parents whose only child coded on the case is turning age 18 in the intervening month will receive the MAGI rede to determine ongoing ACA adult eligibility.
    • Special Message: Our records indicate that your youngest child is turning 18. So that we can determine if you are eligible for another medical program, you must complete and sign this form.
  • ACA Adults turning age 65 in the intervening month will receive the non-MAGI rede to determine ongoing AABD eligibility.
    • Special Message: Our records indicate you are turning age 65. So that we can determine if you are eligible for another medical program, you must complete and sign this form.
  • ACA Adults who will begin receiving Medicare for the target month will receive the non-MAGI rede form to determine ongoing AABD eligibility.
    • Special Message: Our records indicate you are going to start receiving Medicare. So that we can determine if you are eligible for another medical program, you must complete and sign this form.
  • Refugee/Repatriate medical cases (Category 00 & 90) that have reached 8 months after entry in the U.S. will receive the MAGI rede to determine eligibility as ACA Adults.
    • Special Message: Our records indicate you will soon lose eligibility under the current medical program. So that we can determine if you are eligible for another medical program, you must complete and sign this form.

The central unit responsible for the rede will review the returned rede form and determine eligibility for the new case. The central unit will reuse the existing case or cancel the existing case and set up a new case, if eligible. If a new case is set up , the worker will reference the old case number in the writeup. Consider the rede form to be an application for the ACA Adult program, Family Health Plans or AABD and determine eligibility without requiring another application. The review form must be signed to establish a new case.

AABD Resource Verification

Beginning 1/1/14, only reverify the value of the customer's resources for AABD medical when the total reported value of countable resources is over the resource disregard ($2,000 for 1, $3,000 for 2) or the FCRC has reason to believe the customer's resources may exceed the resource disregard.

Continue to verify the value of resources for AABD cases at application or when reviewing a MAGI case to determine eligibility for AABD. Resources are not verified for MSP eligibility.

Reporting the Rede

Workers in the central rede units will record the redetermination in ACM and make any necessary changes to the case. Any notices for cases that change benefit groups (for example, an Assist case changing to Share or an AABD case going into spenddown) will continue to be sent from the CDB based on the changes made in ACM.

The central unit worker will enter the case results in Max-IL after eligibility has been entered in ACM. The worker can enter Changed, Canceled, or Continued as options in Max-IL. Enter:

  • 'Changed' when income or household changes cause the medical case to change to another medical benefit program level (an Assist case changing to Share or an AABD case going into spenddown). Notice will be sent from the CDB;
  • 'Canceled' when the case is no longer eligible. Notice will be sent from the CDB;
  • 'Continued' when the same people (no one was added or removed) are eligible in the same medical benefit program level. A Continuation Notice will be sent by Max-IL automatically.

A separate policy memo is being issued about processing MAGI cases in the Automated Case Mangement (ACM) system.

[Signed]

Michelle R. B. Saddler, Secretary

Illinois Department of Human Services

Julie Hamos, Director

Illinois Department of Healthcare and Family Services