Illinois Department of Healthcare and Family ServicesIllinois Department of Human Services

07/23/15

Summary

  • ACA Adults who start receiving Medicare or who turned age 65 are not eligible as ACA Adults.
  • On July 1, 2015 there was a one-time mailing to ACA Adults with SNAP, who turned age 65 or who receive Medicare. They were mailed HFS 643C, AABD Medical Eligibility Review.
  • Review Mobius reports #84504461 and #84504462 for the listing of individuals who are mailed HFS 643C. 
  • Allow 14 calendar days for return of HFS 643C.
  • When processing the redetermination, review manual release, Simplified Processing for Determining Income and Resource Eligibility for Medical Benefits, dated 12/08/14.
  • Review PM 19-02-03-b, Proving Eligibility, for additional information on determining eligibility for AABD medical.
  • For persons receiving Medicare Part A, review eligibility for the Medicare Savings Program (MSP).
  • Review SNAP eligibility when processing the medical redetermination.

Persons age 65 or receiving Medicare do not qualify for ACA Adult.  When an ACA Adults reaches age 65 or begins receiving Medicare, review medical eligibility to determine if the person continues to qualify for medical benefits in another group before canceling the medical case. 

REDE Notice

Maximus sends REDE forms to medical only cases when a person on ACA Adult turns age 65 or begins receiving Medicare.  For more information see policy memo, Changes to the Illinois Medicaid Redetermination Project (IMRP) revised, dated 06/06/14.

However, REDE forms are not mailed to medical cases that have SNAP benefits.  There was a one-time mailing on July 1, 2015, for persons who receive medical as ACA Adults with SNAP but have aged out of ACA Adult or begun receiving Medicare. They were mailed HFS 643C, AABD Medical Eligibility Review.  Review Mobius reports #84504461 and #84504462 for the listing of individuals who are mailed HFS 643C.

Action on REDE

Allow 14 calendar days for return of HFS 643C. 

Never require a person to come to the FCRC to complete a medical REDE.  When the REDE is returned determine medical eligibility under AABD.  Refer to PM 19-02-03-b for guidance on processing the REDE.

Determine eligibility for AABD medical and MSP (Medicare Savings Program) when completing the REDE.  Since the ACA Adult income standard is higher that AABD medical, a persons may be ineligible for AABD medical due to income exceeding the income standard but may be eligible for MSP.

If the customer does not respond to the notice, cancel the medical case.  Do not cancel SNAP benefits. 

Action on SNAP Benefits

Review SNAP eligibility when processing a medical REDE. Consider any new information reported on the medical REDE as a change reported for SNAP. 

Reinstating Canceled Cases

Review eligibility for a medical case when the client cooperates with the REDE by submitting all required documents prior to end of the third month (or 90 days if longer) following the last day of coverage. See PM 19-04-02.

[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