MR #14.33: Simplified Processing for Determining Income and Resource Eligibility for Medical Benefits

Helping Families. Supporting Communities. Empowering Individuals.

Illinois Department of Healthcare and Family Services logoIllinois Department of Human Services logo

12/08/14

Summary:

  • Public Act 98-0651 authorizes a simplified process for determining initial and ongoing financial eligibility for medical benefits in certain circumstances.
  • Effective immediately, apply this policy when determining eligibility at initial application, at redetermination and when changes are reported.
  • Accept receipt of Supplemental Security Income (SSI) as verification of financial eligibility for both income and resources for individuals who are receiving SSI.
  • Accept receipt of SSI as verification of financial eligibility for individuals who were receiving SSI when they were admitted to a nursing facility. 
  • Accept the individual's current written statement declaring that their resources are below the resource standard for the program, unless questionable, when their verified income is at or below 100% Federal Poverty Level (FPL).
    • A current written statement of resources is information reported on an application or on a redetermination form.
  • Require a current written statement of resources when a change is reported that could affect financial eligibility.
    • Use HFS 2378DR (N-11-14)(pdf), Form HFS 2378DR, Declaration of Resource Information, when a change is reported and a current written statement of resources is required. 
  • Verify resource transfers for all individuals applying for or receiving Long Term Support Services (LTSS)
  • This policy applies to Community and LTSS applicants and clients.

Example 1: Mr. M is admitted to a nursing home on 12/20/14 and applies for medical benefits the same month. On his application he stated that he gets $710 per month in SSI. His SSI is verified electronically using SOLQ. Mr. M qualifies for simplified processing since he receives SSI and financial eligibility has been determined by the Social Security Administration.

Example 2: Ms. J reports on her redetermination form that she receives $900 in Social Security disability benefits. She has $1,500 in the bank and $800 in a retirement account. Ms. J's income can be verified through SOLQ and is under 100% FPL. She reported $2300 in resources on her redetermination form. Her resources exceed the resource standard therefore she does not qualify for simplified processing. Client is required to provide verification of her resources before the redetermination can be processed.

Example 3: Mrs. P, applies on 12/26/14. She receives $810 per month in Social Security disability and is employed making $300 per month. The caseworker verifies her earned income through The Work Number. After allowing the earned income deductions, her total countable income is $960 which is below 100% FPL. Mrs. P reported on her application that she has $1,100 in a bank account and $18,000 in a retirement account. Her declared resources exceed the AABD resource standard. However, since she has a disability and is employed, she may be eligible for the Health Benefits for Workers with Disabilities (HBWD) Program. Mrs. P's application is transferred to the HBWD unit for review where she qualifies for simplified processing.

Example 4: Ms. X enters into a nursing home and applies for LTC on 12/12/14. She receives $972 per month in Social Security benefits. Income is verified electronically through SOLQ. Ms. X reported on HFS 3654, Additional Financial Information for Long Term Care Applicants, that her countable resources were below $2000. She also reported transferring some of her resources to her daughter. Because of the transfer, she does not qualify for simplified processing. Review the transfer of resource policy when determining eligibility.

Example 5: Mr. Z is a senior receiving medical benefits while residing in the community. When his redetermination is due, Mr. Z returns the redetermination form and reports receiving $855 per month in Social Security benefits but does not fill in any information about his resources. Because Mr. Z has not provided a written statement declaring the amount of his resources, he does not qualify for simplified processing. Send Mr. Z form IL 444-1721, Instructions to Client and request verification of his resources.

Example 6: Mr. Y lives in the community and is receiving medical benefits. He receives SSI in the amount of $184 per month and SSA in the amount of $557 per month. Mr. Y contacts his caseworker to report that he got married. He reports that his new wife receives SSA in the amount of $525 per month and her income is verified through SOLQ. The caseworker checks SOLQ to verify that Mr. Y still receives SSI. Since Mr. Y still receives SSI he is eligible for simplified processing based on receipt of SSI as verification of financial eligibility.

Example 7: Ms. S lives in the community and is receiving medical benefits. She receives SSI and SSA. Mrs. S contacts her caseworker and reports her SSA benefits have gone up and her SSI benefits were cancelled.  Caseworker electronically verifies through SOLQ that the SSA benefits are below 100% of FPL. The caseworker sends form IL 444-1721, Instructions to Client, with HFS 2378DR. When HFS 2378DR is returned, the caseworker determines if Ms. S is eligible for simplified processing based on her declared resources.

 MANUAL REVISION

[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 Referenced

HFS 3654

HFS 2378DR (N-11-14)

IL 444-1721