Illinois Department of Healthcare and Family ServicesIllinois Department of Human Services

07/30/15

Action Memo

Summary:

  • Persons admitted to the U.S. as refugees, asylees, Cuban/Haitian entrants or an equivalent status continue to be exempt from enrollment into a Managed Care Organization (MCO).
  • The Recipient Data Base (RDB) identifies refugees as MCO exempt when they are in a case with a basic number that begins with 'A' or 'Y'.
  • Due to a system defect, an 'A' or 'Y' basic is not being assigned to some cases that contain refugees, and as a result they are getting MCO enrollment packets in error.
  • If a refugee or their representative contacts the FCRC to request to be exempt from MCO enrollment, the worker must review the immigration status and assign a case number with an 'A' or 'Y' basic if any person in the case continues to be in refugee/equivalent status.
  • If the person has been a legal permanent residence (LPR) for at least 5 years or is now a U.S. citizen, update the refugee's immigration status code in Item 74. The person is no longer considered to be in refugee status and is no longer exempt from MCO enrollment.

Background

The Illinois Department of Public Health coordinates health assessment and screening for Illinois refugees who often have unique medical needs. Additionally, the Department of Human Services funds several agencies to provide refugees with medical case management and other services for up to five years. For this reason, persons who are identified as refugees, asylees, Cuban/Haitian entrants, or an equivalent status listed in PM 03-01-02-d are exempt from enrollment into a Managed Care Organization (MCO).

Cases with refugees are identified with a basic number that begins with 'A' or 'Y' (see WAG 27-01-04-a). Due to a system defect, an 'A' or 'Y' basic is not being assigned to some cases that contain refugees who have been in refugee status for more than 8 months. As a result they are getting MCO enrollment packets and being enrolled in MCOs in error.

Refugee Requests to be Disenrolled from MCO

The Special Units office (LO 209), is the contact office for agencies that provide services to refugees in Cook County. Outside of Cook County, the agencies will contact the FCRC in which the client's case is maintained. The majority of refugees outside of Cook reside in Dupage, Winnebago and Rock Island counties.

Until IES Phase 2 is implemented, if a refugee or their representative contacts the FCRC to request to be exempt from MCO enrollment, first ask them if the person is now a U.S. citizen or in LPR status for 5 years. If yes, let them know that they are no longer exempt from MCO enrollment. Verify their citizenship status or their immigration status through SAVE (Systematic Alien Verification of Entitlements), and update the citizenship/immigration status code in Item 74 (see WAG 27-74-00). 

If a person in the case continues to be in refugee/equivalent status, use IPACS to close out the former case number using TA 62 and reassign a case number with an 'A' or 'Y' basic. Advise the client or representative when the person(s) can expect to be disenrolled from the MCO. They will not get a separate notice.

  • When the action is taken prior to schedule cut off for the following month, the individuals on the case will be disenrolled from the MCO effective the following month.
  • If the action is taken after schedule cut off, the individuals will be disenrolled effective the month after the following month.

Correcting Immigration Status Ongoing

At REDE, immigration status must be verified through SAVE for noncitizens if the status is subject to change (see PM 19-02-02-b).

After IES conversion, a person's individual immigration status, rather than a case basic number, will be used to identify refugees who are exempt from MCO enrollment. To avoid persons who are no longer refugees from being disenrolled from MCOs after IES conversion, it is important to update their immigration status code in Item 74 as required.

[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