07/02/2020
Policy Memo
Summary:
Both the federal and state governments have declared the COVID-19 pandemic as an official disaster occurrence. Due to these declarations, effective immediately a diagnosis or suspicion of COVID-19 qualifies as an emergency for non-citizens who do not meet federal Medicaid qualifying eligibility criteria.
COVID-19 Diagnosis
Due to the COVID-19 emergency declaration, non-citizens who do not meet federal Medicaid qualifying eligibility criteria and are diagnosed with COVID-19 or suspected of having COVID-19 are eligible for emergency medical coverage without CAU approval. The non-citizen applicant must meet all other eligibility criteria as described in form 3801. See MR #18.05: Emergency Medical Coverage for Noncitizens Not Meeting Immigration Status.
Report of Medical Treatment
The Medicaid application for COVID 19 Emergency Medical must include documentation from a medical professional that COVID-19 is either diagnosed or suspected. The application must include documentation that provides the name of the medical professional attesting to the diagnosis or suspected diagnosis, and date of diagnosis, or a signed and dated copy of form 3801 (attached) with the diagnosis or suspected diagnosis of COVID 19. We are encouraging medical professionals submitting the applications to include the information in the comments section of the application to avoid the need to submit additional paperwork
NOTE: If the Form 3801 is submitted instead of other documentation for a COVID 19 emergency, it is not necessary to provide a response to the question below. However, the COVID diagnosis or suspected diagnosis, and the date on which it occurred must be included on Form 3801. If Form 3801 is not submitted, a response must be provided to the question below.
Eligible individuals will receive an initial sixty (60) days of emergency medical coverage. Contact HFS Policy at 217-557-7158 when treatment for COVID-19 is required for more than 60 days.
COVID-19 Emergency medical coverage period is authorized for 60 days from the start date of coverage. The start date is determined by the date on which the COVID diagnosis or suspected diagnosis was made.
Medical coverage for emergency COVID-19 diagnosis or suspected diagnosis begins the earlier of:
- Date of COVID-19 diagnosis or suspected diagnosis on a completed 3801 or other documentation; or
- the date of application submittal if submitted by a medical professional.
Note: Eligibility staff must process COVID 19 emergency medical applications upon receipt of form 3801 or other documentation supporting a COVID diagnosis or suspected diagnosis. These applications should be completed, or additional information requested if necessary.
Note: Do not forward applications with a diagnosis or suspected diagnosis of COVID-19 to CAU. If an emergency application for a COVID-19 individual is received from CAU, prioritize the application for processing upon receipt.
Presumptive Eligibility
Applicants who are not citizens or do not have satisfactory immigration status are not eligible for Adult PE.
VCL
When an application is received for an applicant who does not meet federal Medicaid citizenship or immigration status requirements and has a COVID 19 diagnosis or symptoms of COVID 19 and does not include a signed 3801 or other documentation from a medical professional, send a VCL for the required documentation.
DATA COLLECTION
Follow the steps below when processing a COVID-19 application for emergency medical coverage:
Under "Individual Information," on the "Questions" page, answer "YES" to "Special Medicaid Approvals." This will cause the "Special Medicaid Approvals Details" page to appear in the driver flow.
On the "Special Medicaid Approvals - Details" page,
- Select the Name of the individual for whom the special approval applies.
- Enter the earliest possible date of the options below in the Circumstances Start/Change Date field.
- Date of application;
- date of email submitted by a Medicaid provider with COVID diagnosis or suspected diagnosis documentation;
- date on a completed 3801;
- date of COVID-19 diagnosis; or
- the onset of COVID-19 symptoms.
- Select 'Emergency Medical Need' as the Approval Type;
- Select 'Provided' for "Has documentation been provided for the CAU referral" field;
- Select 'Yes' for the "Is CAU Decision Received" field;
- Select 'Approved' for the "Enter the CAU Decision" field;
- Enter the begin date (same date as entered for the CSCD);
- Add 60 days to the approval begin date and enter as the end date;
- When finished, click [Save + Continue]; and
- Enter a case comment noting the actions taken.
[signed copy on file]
Grace B. Hou
Secretary, Illinois Department of Human Services
Theresa Eagleson
Director, Healthcare and Family Services
Forms Referenced
Form 3801
