Healthcare and Family ServicesDepartment of Human Services

07/16/14

Policy Memo

Summary

  • The Integrated Eligibility System (IES) is designed to systematically perform case progression when determining eligibility for most cash and medical benefits.
  • Persons approved for Temporary Assistance for Needy Families (TANF), AABD Cash are deemed eligible for medical benefits.
  • IES will automatically determine eligibility for medical benefits when a case is determined ineligible for cash benefits.
  • A temporary process for progressing a case to AABD medical is explained below.

The Integrated Eligibility System (IES) is designed to automatically perform case progression in most instances. Case progression is the process used to determine the most beneficial program for the eligible applicant/client. Currently, IES will not automatically progress cases to AABD medical. The temporary process to change a case to AABD medical is explained below.

  1. Case Progression
  2. Reviewing Changes in Eligibility
  3. Temporary Procedure for Changing Case to AABD in IES
  4. Questions?

Case Progression

If requested, IES will assess eligibility for the three cash programs in the order listed below before reviewing for another program:

  • Temporary Assistance for Needy Families (TANF) (if eligible, deemed eligible for FHP medical at Family Assist level)
  • AABD Cash (if eligible, deemed eligible for AABD medical)
  • Refugee Resettlement Program (RRA Cash)

If not requested or not eligible for any of the above programs, IES will proceed as follows based on the status of each applicant:

Family Heath Plan

  • Parent and caretaker relative
  • Children
  • Pregnant Women

IES will review eligibility for the following when applicant/client is ineligible for those listed above in the following order:

  • ACA Adult
  • AABD Medical without a spenddown
  • AABD Medical with a spenddown (only when spenddown can be met)
  • Health Benefits for Workers with Disabilities (HBWD)
  • QMB Only
  • SLIB Only
  • QI-1 Only

HBWD cases are processed by HFS Central Office.  IES is programed to identify cases that are potentially eligible for HBWD. Cases identified as being potentially eligible are transferred to Local Office 250 for processing.

Reviewing Changes in Eligibility

If an existing case becomes ineligible for assistance, the same case progression should be used in determining if the client is eligible for other coverage.

Temporary Procedure for Changing Case to AABD in IES

If a person receives RSDI and income is over 138% FPL determine eligibility for AABD Spenddown before referring to the Marketplace.  When an AABD medical determination is needed, go back to 'Register Individual-Eligibility' page in the 'Other Information' section and review the following responses. The following questions automatically default to No. Change response as indicated below.

Question Response
Is the individual currently in a long term care facility, seeking to enter a long term care facility, or need help with activities of daily living through personal assistance services? Select YES
Does the individual have a Social Security Claim Number (SSCN) or Railroad Retirement Number (RRN)? YES, if an individual receives Social Security benefits of any kind.
Does the individual have a disability? If applicable, select YES.
Is the individual currently receiving Medicare, Social Security Disability, or SSI? Select YES if YES was selected for the SSCN question.
Is the individual currently in a long term care facility, or need help with daily living activities through personal assistance services? Select YES.

Questions?

Questions about case processing in IES should be directed to your IES Expert. If staff have questions about case progression, they may call the Bureau of Medical Eligibility and Special Programs (BMESP) at 217-557-7158.

[Signed]

Michelle R. B. Saddler, Secretary

Illinois Department of Human Services

Julie Hamos, Director

Illinois Department of Healthcare and Family Services