Illinois Department of Healthcare and Family ServicesIllinois Department of Human Services

06/25/15

Action Memo

Summary:

  • When a child reaches age 19, we are required to determine whether the child continues to qualify for medical benefits under another medical program before canceling benefits under the All Kids program.
  • We are also required to determine whether a parent or caretaker relative who receives FamilyCare continues to qualify for medical benefits under another program when the youngest child ages out of All Kids.
  • Redetermination forms are being sent by Maximus to medical only Family Health Plans (FHP) cases before the child reaches age 19.
  • However, redetermination forms are not being centrally mailed to FHP cases that have SNAP benefits for children who are aging out.
  • The PAL code 'A' identifies Family Health Plans cases with a child turning age 19.
  • Effective immediately, send Medical Renewal Form (HFS 643) to cases appearing on the PAL list with code 'A'.
  • A client who has already been deleted or canceled due to a child aging out may be reinstated when a REDE is completed within 90 days of cancellation when they continue to qualify for medical benefits.

  1. Temporary Procedure for PAL Code A
    1. Casework Action
    2. Who Signs the Medical REDE Form?
    3. When is a Automatic Negative Action Taken?
    4. Continuing SNAP on a Canceled FHP Case
    5. When Must the Worker Take the Negative Action?
  2. Resuming Canceled Cases
  3. Forms referenced

(Table of Contents link here if headings are used.)

When a child reaches age 19, we are required to determine whether the child continues to qualify for medical benefits under another medical program before canceling benefits under the All Kids program. We are also required to determine whether the parent or caretaker relative qualifies for continued medical when they no longer qualify for FamilyCare due to the only child aging out.

Maximus sends REDE forms to medical only cases when a child on an All Kids case will turn age 19. For more information see the policy memo, Changes to the Illinois Medicaid Redetermination Project (IMRP) Revised.

However, REDE forms are not being mailed to medical cases that have SNAP benefits for children who are aging out of the All Kids program at age 19.

For this reason, staff must manually send the Medical Renewal Form (HFS 643) to clients who appear on the PAL list with code 'A' until IES Phase 2 is implemented (see WAG 19-06-01 for information about PAL codes).

Temporary Procedure for PAL Code A

This code identifies a child who will reach age 19 the month of the PAL. 

Casework Action

  1. Send Form 1721 with Form HFS 643 (R-1-14)/HFS 643S (R-1-14) (pdf) to the 19 year old with the following 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, sign and return this form."
  2. If there is a parent or caretaker relative on the case with no other remaining dependent children, also send Form 1721 with Form HFS 643 to the parent/caretaker with the following message: 
    • "Our records indicate that your youngest child is turning 19. So that we can determine if you are eligible for another medical program, you must complete, sign and return this form." 
  3. When the customer responds to the notice, determine continued eligibility under the ACA Adult program, or another medical programs if applicable (for example, FamilyCare if 19 year old has a dependent child).
  4. If the customer does not respond to the notice, delete the individual or cancel the medical case effective the month after the child turns age 19 when an automatic negative action is not taken. See the section below titled, "When Must the Worker Take the Negative Action".

Who Signs the Medical REDE Form?

Individuals who are determined to have  continued eligibility under the ACA Adult program or a FHP use MAGI budgeting rules. The policy contained in PM 02-04-03 about who can sign an application for MAGI benefits applies to the redetermination form as well.

That is, a tax filer or other adult who is included in the tax filer's tax household may apply and sign an application on behalf of all of the individuals who are included in the tax filer's household.

Example 1: The youngest child is turning age 19 and a REDE form is sent to both the parent and the 19 year old. The form is returned by the parent who indicates that he will file taxes and claim the 19 year old as his tax dependent. Use the REDE form that is signed by the parent to set up an ACA Adult case for the parent, and a separate ACA Adult case for the 19 year old with the parent as the RPY.

Example 2: Same household as above, except that both the the parent who will file taxes and the 19 year old tax dependent sign and return their individual REDE forms. Set up ACA Adult cases for both the parent and the 19 year old under their own names. The parent's income must be counted in the 19 year old's EDG.

Example 3: Same household as above, except that neither person will claim the other as a tax dependent. Both individuals must sign and return their own REDE form.

When is a Automatic Negative Action Taken?

  • When there's another child in the case and the 19 year old is not pregnant and does not have a disability (i.e., no EDD in Item 60, no disability income in Item 90), the system deletes the 19 year old (using TA 36/TAR 04) if the worker does not take action to delete the child by schedule cut-off for the month after the child reaches age 19.
  • When there is not another child in the case, and no one in the case is pregnant, has a disability or is age 65 or older, the system cancels the case (TA 28/TAR 76) if the worker does not take action to cancel the case by schedule cut-off for the month after the child reaches age 19.

Continuing SNAP on a Canceled FHP Case

If SNAP benefits are on the canceled case, the following batch exception message "Review Food Stamp Eligibility. Open Category 8 case if eligible." alerts the worker to complete a separate review of ongoing SNAP eligibility for the SNAP unit and set up a category 08 case if eligible. See PM 18-04-11.

When Must the Worker Take the Negative Action?

  • When there's another child in the case and the child is pregnant, has a disability or is a minor parent (i.e., EDD in Item 60 or disability income in Item 90 or code 6 in Item 69), the child is not centrally deleted.
  • When there is not another child in the case, and a person is pregnant, has a disability, is age 65 or over, or is a minor parent,  the case is not centrally canceled.

Resuming Canceled Cases

If the case is canceled or the person is deleted because the REDE notice was not returned, medical benefits may be resumed if the customer completes the REDE within 90 days of the effective date of cancellation. Additionally, resume medical benefits without requiring a new application if the customer completes the REDE within 90 days in situations where a REDE notice was not sent prior to the negative action. In this situation, resume benefits starting with the date coverage ended.

[signed copy on file]

James T. Dimas

Secretary designate, Illinois Department of Human Services

Felicia F. Norwood

Director, Illinois Department of Healthcare and Family Services

Forms referenced

  • Form 1721
  • Form 643