MR#17.17: IES Case Composition, Office Functions Changes and FHP Updates

Helping Families. Supporting Communities. Empowering Individuals.

Illinois Department of Healthcare and Family ServicesIllinois Department of Human Services

10/19/17

Obsoletes Policy Memoranda: "FamilyCare Share, Premium and Rebate Ends for Adults" dated 06/06/12, and "All Kids Rebate Ending 12/31/13" dated 11/04/13.

Summary:

  • An IES case can contain combinations of programs that were not possible in the legacy system; under IES Phase 2, the entire household can remain in the same IES case in most situations.
  • New rules about when to split and when to merge cases in IES will apply.
  • Due to the case structure changes under IES Phase 2, case maintenance assignments for certain types of cases will change:
    • IES cases that have both All Kids Share or All Kids Premium EDGs, and SNAP or Cash EDGs must be certified and maintained by DHS FCRCs.
    • Medical only cases that have All Kids Share and Premium and other medical EDGs, may be certified by either the central All Kids Unit (AKU) or FCRCs, however should be transferred to and maintained by the central AKU. 
    • Health Benefits for Workers with Disabilities (HBWD), Veterans Care (VC), and Health Benefits for Persons with Breast or Cervical Cancer (BCC) cases that have requests for cash or SNAP benefits need to be split because these medical programs can be certified by the HFS central offices only, and cash and SNAP can be certified by DHS FCRCs only. 
  • The Medical Management Unit (MMU Office 155) will continue to maintain medical only cases with Family Heath Plans (Family Assist, Medical Extension, FamilyCare Assist, All Kids Assist, Moms & Babies, Family Health Spenddown), ACA Adult, and Former Foster Care, as well as AATV cases that are outside of Cook County, see 7/25/17 Action Memo: Case Transfers in the Legacy System/New Office Medical Management Unit.
  • Medical only cases with HBWD, VC, or BCC will continue to be maintained by HFS central offices.
  • Medical only Long Term Care and Supportive Living Program cases (other than LTC cases for persons receiving Department on Aging community services) will continue to be certified and maintained by the Medical Field Offices.
  • The Stroger office will continue to receive and certify medical only applications received from Cook County Health & Hospital Systems (CCHHS), and will maintain medical only cases resulting from these applications for the following programs: Family Assist, FamilyCare Assist, All Kids Assist, Moms & Babies, ACA Adult, Family Health Spenddown, Former Foster Care and Medicare Savings Programs.
  • Medical cases for persons approved for the Medically Fragile Technology Dependent (MFTD) waiver will continue to be certified and maintained by the DHS Central Office 238.
  • This release also updates the manual to remove references about FamilyCare Share, Premium and Rebate that ended in 2012, and All Kids Rebate that ended in 2013.

  1. CDB to IES in Phase 2
    1. When Should a Case With the Same HoH Be Split in IES?
    2. Which Cases Should Be Merged in IES?
    3. When is the Best Time to Merge Cases?
    4. Cases in Same Household with Different HoH/Payee
  2. Which Offices Can Certify & Maintain Which Programs?
    1. Cases Maintained by FCRCs
    2. Cases Maintained by MMU
      1. Transfers to MMU
    3. All Kids Share and Premium Cases with Cash or SNAP
      1. AKU Support for All Kids Share/Premium Cases Maintained by DHS FCRCs
    4. HBWD, VC or BCC Cases (Cash or SNAP Requests)
  3. Removing References to All Kids Rebate and FamilyCare Share/Premium/Rebate and Miscellaneous Updates
  4. MANUAL REVISIONS

CDB to IES in Phase 2

In the legacy data base known as the Client Data Base (CDB), households requesting multiple programs were often split into multiple cases. For this reason, in Phase 1 some cases that were approved in IES had to be split before being sent to the Client Data Base (CDB).

Under IES Phase 2, in most situations the entire household can remain in the same IES case because an IES case can contain combinations of programs that were not possible in the legacy system. These new combination cases require changes regarding which office may certify and maintain cases with multiple program EDGs. This also requires new rules about when cases should be split, and when cases can be merged.

After conversion, most cases that have the same head of household (HoH), also known as the 'payee', should be merged into one IES case. Having one case for a family who lives together is easier for the client and promotes good customer service. However, there are still a few situations that require that an application or case be split. Also, there are some situations where cases with the same payee should not be merged.

When Should a Case With the Same HoH Be Split in IES?

Programs Message or Action
HBWD, VC or BCC that requests cash or SNAP A case split message appears on the certification page requiring the worker to split the HBWD, VC or BCC component onto a separate IES case.
LTC (NH and SLP)

An application or case for a person in a LTC facility should always be single person cases, even if they contain 2 spouses who reside in the same facility.

The only time there should be more than one person on the case is when a community spouse or dependent is listed as a non-requester for the purpose of an income or resource diversion.

An IES case split message has been requested, however it may not appear until after Phase 2 implementation.

Multiple cash EDGs (AABD, RRP & TANF, or more than 1 AABD cash) This message appears on the certification page: Multiple Cash EDGs can't be certified on the same case. Please navigate to the program request page, withdraw the cash request for the individual(s) and split the case.
Multiple SNAP EDGs or multiple TANF EDGs Not possible on the same IES case.
MFTD Waiver Recipients Medical cases for persons approved for the Medically Fragile Technology Dependent (MFTD) waiver continue to be certified and maintained by the DHS Bureau of Local Office Transactions and Support Services, Office 238, unless they are included in a TANF case (see PM 06-11-01).

Note: A case is split only when the same application can be used to determine eligibility for all of the cases involved. When the same application cannot be used to determine eligibility for all of the cases involved, process a denial for persons who need to apply separately. See PM 02-04-03 for more information about who can sign an application.

  • Example 1: Mom applies for herself and her 21 year old son. Neither Mom, nor her son are tax filers. They both potentially qualify for the ACA Adult program. Since they are not part of the same tax filer household, the adult son must file a separate application.

Which Cases Should Be Merged in IES?

The cases described above that are required to be split, must not be merged with other cases, even if they have the same HoH. Otherwise, all other cases with the same HoH can be merged.

After Phase 2 implementation, Potential Merge Cases will be identified in the Conversion Summary Information section on the Case-Search Summary page. A Potential Merge Case situation occurs when two or more cases have the same HoH based on an Individual ID match. Staff decides at what point to merge the cases.

Refer to the Resource Center for IES for information about how to merge cases. When two or more cases are merged, one case is identified as the target case, and the other cases are source cases. The target case is the case that will be retained ongoing. The individuals on the source case(s) will be approved and certified into the target case, and the source case(s) will be canceled. This action will result in a notice of decision to inform the client about persons added to the target case, and any resulting changes to the target case. A cancellation notice for the source case is not sent.

If the cases are in different offices, the source cases must be transferred to the office where the target case is. The merge action should be completed in the target case office. If the cases contain different addresses, confirm that the target case has the correct address before merging.

Potential Merge Cases are excluded from the Auto-REDE process (see WAG 19-02-04).

When is the Best Time to Merge Cases?

The best time to merge cases is when a redetermination, or other change, is due to be processed on one of the EDGs.

When cases are merged, the original certification periods for each EDG are retained. Once merged, the goal is to align the certification periods on the IES case whenever possible. In order to align the cert periods, when a REDE is due for a SNAP or medical EDG on the case, IES allows an early REDE to be completed for other medical EDGs on the case as long as the early REDE does not violate continuous eligibility policy (see PM 19-02-07).

Whether or not the EDGs can be aligned, it is best to merge cases when a REDE is being processed. When a REDE is processed on the same day after a merge action was taken on the case, the notice for the REDE (the latter action) will override the notice that would have been sent as a result of the merge action.  This will result in less client confusion about any resulting changes taking place as well as confusion due to multiple notices.

  • Example 2: Ms. Jackson has an All Kids Share case for her granddaughter and an ACA Adult case with SNAP for herself and her granddaughter. The AK Share case is at the All Kids Unit and the ACA/SNAP case is at a FCRC. The cases are identified as potential merge cases. The AK Share case has a certification period ending in June 2018. The ACA/SNAP case has a certification period ending in February 2018.
  • Prior to processing the REDE in January 2018, the FCRC worker contacts the AKU to request that the Share case be transferred to the FCRC to be merged. The FCRC worker merges the cases. On the same date the worker certifies the REDE for all the EDGs. Ms. Jackson is approved for FamilyCare and her granddaughter continues to qualify for AK Share. Since continuous eligibility is maintained for the child, her new certification period is aligned with her grandmother's medical & SNAP EDGs (March 2018 to February 2019). One form 360C Notice of Decision is sent to the client.

Cases in Same Household with Different HoH/Payee

You may have more than one case in the same household that have members in common, but have different payees. That may occur in situations where cases cannot be combined, such as when you have two SNAP EDGs of unrelated persons who do not buy and prepare meals together, or two separate TANF EDGs in the same household.

On the other hand, there will be some Medical only cases in the same household that can be merged, but are not required to be merged. If the clients choose to have multiple medical cases merged, they must decide who will be the head of household for the combined case. That case will be the target case.

  • Example 3: Mr. and Mrs. Smith live together and have separate ACA Adult cases in their own names. Mrs. Smith contacts the FCRC to report an address change for herself and her spouse. The worker advises Mrs. Smith that they may choose to have the cases merged for their convenience. Mr. and Mrs. Smith decide that they want their cases to be merged, and that Mrs. Smith will be the HoH. Mrs. Smith's case is identified as the target case. When the cases are merged a notice is generated for the target case. A cancellation notice is not generated for the source case.
  • Example 4: Mr. Jones receives FamilyCare for himself and All Kids Assist for his two children, Tom age 18 and Sandra, age 14. He files taxes and claims both his children as dependents. When Tom reaches age 19, his All Kids benefits are terminated. Mr. Jones may request that Tom be added back to his case (as an ACA Adult) because Tom is his tax dependent, or Tom may apply for medical benefits on his own behalf. Tom is not required to be in his father's case. However if he applies separately, his father's income must be taken into consideration because he is being claimed as his father's tax dependent.
  • Note: When IES has information that the 19 year old who is aging out of a case is in the same tax filer unit as the HOH, the system will automatically determine whether the 19 year old qualifies for the ACA Adult program. However, since the CDB does not contain tax filer information to send to IES at case conversion, IES will apply relationship rules to MAGI cases until staff have entered tax filer information into Data Collection.

SNAP and cash cases may also be merged with medical cases at the customer's request. When SNAP or cash is merged with a medical only case, IES will default the SNAP or cash case to be the target case. This ensures that the person who is the payee on the LINK account can continue to access SNAP or cash benefits without delays.

  • Example 5: Mr. and Mrs. Jones live together and have separate ACA Adult cases in their own names. Mr. Jones' case contains a SNAP EDG in which they are both included and is maintained at the local FCRC. Mrs. Jones' ACA Adult case is maintained by MMU. During the SNAP REDE, Mr. Jones requests that their cases be merged for their convenience. The worker advises them that since Mr. Jones' case contains SNAP, he would be identified as the HoH (target case). They decide that they want their cases to be merged. The FCRC worker requests MMU to transfer Mrs. Jones' medical case to the FCRC for the purpose of merging it with Mr. Jones' case. When the FCRC worker merges the cases a notice is generated for the target case. A cancellation notice is not generated for the source case.

Which Offices Can Certify & Maintain Which Programs?

Office New Application Routing REDE, Case Change, Case Progression Actions Ongoing Maintenance
DHS FCRC
  • SNAP
  • Cash
  • Medical
  • Cash (TANF, AABD cash, or RRP)
  • SNAP
  • Medical:
    • Family Assist
    • Medical Extension
    • FamilyCare Assist
    • Moms & Babies
    • All Kids Assist
    • All Kids Share
    • All Kids Premium
    • ACA Adult
    • Former Foster Care 
    • AABD community
    • AABD community spenddown
    • Family Health Spenddown
    • MSP (QMB, SLIB, QI-1)
    • *AATV
  • Cash (TANF, AABD cash, or RRP)
  • SNAP
  • AABD community and AABD community spenddown (with or without SNAP/cash)
  • Other Medical when combined with SNAP or cash
All Kids Unit Medical
  • Marketplace Applications
  • BCC applications from the Illinois Breast and Cervical Cancer Program (IBCCP)
Medical only:
  • Family Assist
  • FamilyCare Assist
  • Moms & Babies
  • All Kids Assist
  • All Kids Share
  • All Kids Premium
  • BCC
  • ACA Adult
  • Former Foster Care 
  • AABD community
  • AABD community spenddown
  • Family Health Spenddown
  • MSP (QMB, SLIB, QI-1)
  • *AATV
Medical only:
  • All Kids Share
  • All Kids Premium
  • BCC
  • Other Medical when combined with All Kids Share, All Kids Premium or BCC 
Medical Management Unit No Initial Applications Medical only:
  • Family Assist
  • Medical Extension
  • FamilyCare Assist
  • Moms & Babies
  • All Kids Assist
  • All Kids Share
  • All Kids Premium
  • ACA Adult
  • Former Foster Care 
  • AABD community
  • AABD community spenddown
  • Family Health Spenddown
  • MSP (QMB, SLIB, QI-1)
  • *AATV
Medical only:
  • Family Assist
  • Medical Extension
  • FamilyCare Assist
  • Moms & Babies
  • All Kids Assist
  • ACA Adult
  • Former Foster Care 
  • Family Health Spenddown
  • MSP (QMB, SLIB, QI-1)
  • *AATV

Medical Field Operations-MFO

 (LO 200, 244 & 163)

Medical

**LTC - Nursing Homes & Supportive Living Facilities only

Medical only - LTC (NH & SLF) Medical only- LTC (NH & SLF)
Stroger

Medical

Cook County Health & Hospital Systems (CCHHS) applications

Medical only:
  • Family Assist
  • FamilyCare Assist
  • Moms & Babies
  • All Kids Assist
  • All Kids Share
  • All Kids Premium
  • ACA Adult
  • Former Foster Care 
  • AABD community
  • AABD community spenddown
  • Family Health Spenddown
  • MSP (QMB, SLIB, QI-1)
Medical only and individual resides in Cook County:
  • Family Assist
  • FamilyCare Assist
  • Moms & Babies
  • All Kids Assist
  • ACA Adult
  • Former Foster Care 
  • Family Health Spenddown
  • MSP (QMB, SLIB, QI-1) when combined with other medical listed above
HFS Special Programs Medical- HBWD Medical only:
  • HBWD (LO 250)
  • Veterans Care (LO 196)
  • Other Medical when combined with HBWD or VC 
Medical only:
  • HBWD (LO 250)
  • Veterans Care (LO 196)
  • Other Medical when combined with HBWD or VC

*Special Units (LO 209) continues to certify and maintain AATV cases in Cook County

**Department on Aging (DoA) cases are also considered to be LTC. However, they are not routed to MFO because they live in the community and may be included in an IES case with other programs and persons.

Cases Maintained by FCRCs

  • Cases with Cash or SNAP EDGs
  • AABD Community (medical only or with SNAP or cash)
  • AABD Community Spenddown (medical only or with SNAP or cash)
  • Other medical cases when the case includes SNAP or cash

Cases Maintained by MMU

  • All medical only Family Health Plans (FHPs) other than All Kids Share or Premium
  • ACA Adult
  • Former Foster Care 
  • MSP (QMB, SLIB, QI-1)
  • AATV (outside of Cook County)

Transfers to MMU

Prior to IES Phase 2 implementation applicable medical only cases are being transferred to MMU, see the Action Memos: Case Transfers in the Legacy System/New Office Medical Management Unit and Actions to Take On Cases Transferred to MMU Office 155.

Some time after Phase 2 implementation, IES will be programmed to automatically transfer designated cases to MMU. However, until IES is updated, FCRCs and the AKU will need to transfer approved medical only cases that will be assigned to MMU for case maintenance to MMU once they have completed initial eligibility determination and certification.

All Kids Share and Premium Cases with Cash or SNAP

All Kids Share and Premium EDGs can be certified in any DHS FCRC, or in the central All Kids Unit if the application does not request cash or SNAP benefits. If the application contains a request for cash or SNAP, it must be certified by a DHS FCRC. After Phase 2 implementation, an IES case can contain both an All Kids Share or Premium EDG and a SNAP or cash EDG.

The All Kids Unit (AKU) will continue to maintain medical only cases with All Kids Share and All Kids Premium EDGs, even if the case contains other medical EDGs that are normally maintained by FCRCs.

However, if a family with an All Kids Share or Premium case that is being maintained by the AKU applies for cash or SNAP, the case must be transferred to an FCRC for a disposition. If cash or SNAP is certified, the case must remain at the FCRC for case maintenance. A case with cash or SNAP benefits cannot be transferred back to the AKU.

AKU Support for All Kids Share/Premium Cases Maintained by DHS FCRCs

FCRC staff may contact the AKU for assistance relating to All Kids Share or Premium cases. Questions can be emailed to All Kids at hfs.allkidscalendar@illinois.gov or by phone at 1-877-805-5312 (select 4).

Contact AKU or refer customers to AKU for the following:

  • Questions about premium payments, or
  • Requests for Prior Coverage when they are made after the AK Share/Premium case  is approved.

IES will process Prior Coverage when an applicant requests backdate for a child who is approved for AK Share or Premium Level 1.  However, when the applicant requests Prior Coverage after the initial approval is certified, refer the customer to AKU.

HBWD, VC or BCC Cases (Cash or SNAP Requests)

  • HBWD can be certified in the HFS Special Programs Office, LO 250 only.
  • Veterans Care (VC) EDGs can be certified in the HFS Special Programs Office, LO 196 only.
  • BCC applications are always medical only applications that are filed directly with the AKU and can be certified in the AKU/BCC office, LO 189 only.

An application for medical benefits that progresses to an HBWD or VC EDG must always be transferred to LO 250 or LO 196. A case transfer message appears on the certification page in IES requiring the worker to transfer the case to LO 250 or 196.

If the application also contains a cash or SNAP request, a message will appear requiring the worker to split the medical component on to a separate case.  The cash/SNAP benefits must be certified by an FCRC, and the medical component certified in the HFS Special Programs office.

HFS Special Programs and the AKU/BCC office will maintain medical only cases that contain an HBWD, VC or BCC EDG, even if the case contains other medical EDGs that are normally maintained by FCRCs. However, if cash or SNAP benefits are requested, the case must be split and the cash/SNAP case transferred to the FCRC for a disposition and case maintenance if certified.

The FCRC may contact the HFS Special Programs Office for assistance with premium issues relating to HBWD cases. Questions can be emailed to  HFS.Webmaster@Illinois.gov

Removing References to All Kids Rebate and FamilyCare Share/Premium/Rebate and Miscellaneous Updates

This release updates the manual to remove references about the FamilyCare Share, Premium and Rebate program that ended in 2012, and the All Kids Rebate program that ended in 2013. Most of the pages updated in this release are for this reason. WAG pages that have been updated may continue to contain worker action guidance pertaining to the legacy system.

Additional changes on affected pages include:

  • Removing references about budgeting child support income for All Kids since child support is not counted under MAGI budgeting policy.
  • Updating and linking All Kids Share & Premium renewal policy to policy regarding reinstating medical cases that were canceled at redetermination when a client cooperates within 90 days.
  • Deleted outdated (pre-MAGI) policy regarding eligibility of 18 year olds.
  • Added references to notices forms that will be generated under IES Phase 2.
  • Clarifies that the maximum monthly All Kids premium charged for a family is $80, even when a family has one or more children in Premium Level 1, and one or more children in Premium Level 2 on the same IES case.

MANUAL REVISIONS

[signed copy on file]

James T. Dimas

Secretary, Illinois Department of Human Services 

Felicia F. Norwood

Director, Illinois Department of Healthcare and Family Services