Healthcare and Family ServicesDepartment of Human Services

06/30/14

Policy Memo

Summary

  • Public Act 98-0651 requires the State to change the review process for applications referred to Long Term Care - Asset Discovery Initiative (LTC-ADI) with application dates prior to 9/1/13.
  • For applications dated prior to 09/01/13, LTC-ADI will send verifications received for the month of application and backdated months to the referring FCRC for processing.
  • Review applications that were denied prior to 09/01/13 due to failure to cooperate, if requested.
  • This procedure applies only to applications dated prior to 9/1/13 returned by LTC-ADI.

LTC-ADI - Applications dated prior to 9/1/13

Pending applications that were referred to the HFS Long Term Care - Asset Discovery Initiative (LTC-ADI) are being returned to the referring Family Community Resource Center (FCRC) for processing. For applications dated prior to 09/01/13, LTC-ADI will send verifications received for the month of application and backdated months to the referring FCRC for processing. The following procedure should be followed:

  • LTC-ADI will scan and send resource verifications for the month of application and the backdated months. LTC-ADI will also send proof of the client's resources to the HFS Bureau of Collections.
  • The FCRC will process the application using the verified resources for the month of application.  The FCRC does not need to verify resources for the months following the application date.  The FCRC does not request verifications for resources already verified by LTC-ADI.  If LTC-ADI does not provide the required verifications for the month of application or backdated months the FCRC will send HFS 276LTC, Instructions to Client  (Long Term Care) to request needed verifications. The FCRC only verifies resources that were not verified by LTC-ADI and are needed to determine eligibility. The FCRC will complete IL-444-0008, Real Property Record, for resources verified by the FCRC that had not been previously verified by LTC-ADI.
  • The FCRC does not further consider resources that were available and resource transfers that occurred during the lookback period.
  • If the FCRC has everything they need to determine eligibility, process the application. If the applicant fails to cooperate, deny the application.
  • If the applicant or applicant's representative or facility questions the resource values used in determining eligibility, the FCRC will re-review the resource assessment. 

Example 1: Mr. Smith applied for LTC on 01/02/13. The application was referred to LTC-ADI for review. Mr. Smith provided proof of his resources for the month of January and for the backdated months (October, November and December). Process the application through the current processing month using the verifications that were provided for the months of application. For the backdated month, use the verifications that were provided for those months.

Example 2: LTC-ADI returns verifications including bank statements, life insurance, vehicle and prepaid burial. The FCRC reviews the original application and determines all reported resources were verified. The FCRC processes the application.

Example 3: LTC-ADI returns verifications including a vehicle and prepaid burial. The FCRC reviews the application and discovers a bank account that had not been verified. The FCRC sends HFS 267LTC to request a bank statement for the month of application and any requested backdate months.

This procedure applies only  to applications dated prior to 9/1/13 and returned by LTC-ADI. Do not apply this procedure to applications dated after 09/01/13 that were referred to LTC- ADI.  Refer to PM 07-02-20 and WAG 07-02-20.

Denials due to Failure to Cooperate with Resource Verifications on Applications dated prior to 9/1/13

Applications dated prior to 7/1/12 have a 36 month lookback. Applications dated 7/1/12 or after have a 60 month lookback. Some LTC applications may have been denied  due to failure to cooperate because the incorrect lookback period was used. The FCRC or LTC-ADI are required to review the denial action taken on applications filed prior to 9/1/13.  The applicant or the  applicant's representative or the facility may request a review of the denial of application filed prior to 09/01/13. 

  • If the LTC-ADI directive was used to deny the application, LTC-ADI will review the request. If LTC-ADI determines that the correct lookback period was applied LTC-ADI will inform the applicant or the applicant's representative and facility that the correct lookback period was applied. If the decision to deny was based on the LTC-ADI directive, LTC-ADI is responsible for the review.
  • If the FCRC denied the application, the FCRC will review the request.  If the FCRC determines that the correct lookback period was applied the FCRC will inform the applicant or the applicant's representative and facility that the correct lookback period was applied. If FCRC used the correct lookback period, LTC-ADI or the FCRC will inform the applicant or the applicant's representative and facility that the correct lookback period was applied
  • If the LTC-ADI directive was used to deny the application and the incorrect lookback period was applied, LTC-ADI will send a revised directive. The FCRC will reopen and process a new eligibility determination.
  • If the FCRC denied the application and determines that the incorrect lookback period was applied, the FCRC will reopen and process a new eligibility determination.

The FCRC will send a revised IL444-0458LTC, Notice of Decision on Application for Medical Assistance to the applicant or the applicant's representative and facility.

Example 4: Ms. J applied 6/20/12 for LTC coverage.  The worker sent HFS 267LTC on 7/2/12, the worker requested transfer information for the previous 60 months. Ms. J did not provide all the information and was denied. Because her application was filed before 7/1/12, the applicant was only required to provide verification for a 36 month lookback period.  Send HFS 267LTC for the correct lookback period.

[signed copy on file]

Michelle R.B. Saddler

Secretary, Illinois Department of Human Services

Julie Hamos

Director, Healthcare and Family Services

Forms referenced:

  • IL444-0008
  • HFS 267LTC
  • HFS 458LTC