Obsoletes Information Memorandum, Increased Copays for Medical Services, dated 3/29/13.
- Updates the various medical program income standards which are based on the Federal Poverty Level Income Guidelines effective 01/01/14.
- Provides the updated Modified Adjusted Gross Income (MAGI) equivalent income standards used to determine initial eligibility under the Family Health Plans (FHPs) and Affordable Care Act (ACA) Adult programs; and used for redeterminations processed effective April 2014 and later.
- Provides updated pre-MAGI standards that will apply to FamilyCare recipients in certain situations when a change is reported prior to their first MAGI renewal.
- The MAGI equivalent income standard for pregnant women is updated to 213% of the FPL.
- This release also places updated medical service copay information into the manual.
- Updates the Program Standards Desk Aid.
- Increase in the Monthly Medical Income Standards
- Using pre-MAGI Income Standards on Grandfathered FamilyCare cases
- Family Health Plans & ACA Adult Income Standards
- Monthly Income Standards for AABD, Medicare Cost Sharing
- Monthly Income Standards for Other Programs
- Family Assist and Family Health Spenddown Standards
- Copays for Medical Services
- Program Standards Desk Aid
- MANUAL REVISIONS
Increase in the Monthly Medical Income Standards
This release places in the manual the updated income standards for the programs listed below based on the 2014 Federal Poverty Level (FPL). The new standards are effective 01/01/14 for all programs except MPE. The new standards are effective for MPE on 02/19/14.
Using pre-MAGI Income Standards on Grandfathered FamilyCare cases
Use new MAGI income standards for FHP REDEs effective for the month of April 2014 and later, and when processing a change in income or family size on a FHP or ACA Adult case.
However, a second eligibility determination using the pre-MAGI (legacy) income standards and methodology is required in the following situation:
- the case was initially determined under legacy budgeting methodology (applications received before 10/1/2013),
- worker is processing a reported change prior to the first regularly scheduled REDE that will use MAGI budget, and
- a FamilyCare recipient becomes ineligible solely due to MAGI budgeting methodology.
Example: Ms. Jones receives FamilyCare and All Kids Assist for her two children, 6 year old Bobby and 3 year old Susie. Initial approval was in 2012 and her next regularly scheduled REDE is due in September 2014. On April 1st she reports that she has a new job and will earn $2,300 per month. She reports that she pays $200 per month for child care and reports no other expenses. Eligibility is calculated for Ms. Jones only (the children retain continuous eligibility per PM 18-05-01).
$90 Employment deduction
+ $200 child care cost
= $290 total deductions
||$2,010 (2,300 - 290)
Since Ms. Jones' countable income is over the MAGI standard, a second calculation is completed using legacy budget. Since her countable income under legacy budget is under the pre-MAGI income standard, she is grandfathered in until her first regularly scheduled REDE under MAGI budget methodology is done.
For more information see upcoming Policy Memo, Renewal Processing and MAGI Calculator.
Family Health Plans & ACA Adult Income Standards
To comply with federal guidelines under the Affordable Care Act, the MAGI income standard for pregnant women is updated to 213% of FPL (that is, 208% plus 5% standard disregard) for new applications. Active Moms & Babies cases maintain continuous eligibility through the 60-day postpartum period.
Monthly Income Standards for AABD, Medicare Cost Sharing
||Link to Amounts
- AABD (community)
- Medicare Cost Sharing (QMB, SLIB, QI-1)
|WAG 25-03-02 (2)
Monthly Income Standards for Other Programs
Family Assist and Family Health Spenddown Standards
There is no change in the Family Assist and Family Health Spenddown standards. Children and pregnant women who qualify for spenddown must spend down to the Family Health Spenddown standard. The Family Health Spenddown program ended for non-pregnant adults effective January 1, 2014 (see policy memo dated 12/11/13, Family Health Spenddown Ending for Non-Pregnant Adults).
Copays for Medical Services
This release places information about medical service copays into the manual. Updated copay amounts and information about groups that are exempt from copays was previously described in an Informational Memo dated 03/29/13.
Program Standards Desk Aid
The Program Standards Desk Aid in WAG 25-03-02 has been updated with the new income standards.
[signed copy on file]
Michelle R.B. Saddler
Secretary, Illinois Department of Human Services
Director, Illinois Department of Healthcare and Family Services