PM 02-05-04
IES Phase 2 Process
In the Integrated Eligibility System (IES), the Program Request Child Presumptive Eligibility screen appears in the Application Registration system as well as the Add Member driver flow for children under age 19. Enter the information needed for IES to determine if the child is eligible for CPE coverage.
Declarations
Declaration means the applicant answered questions on the application regarding the child's U.S. citizenship, satisfactory immigration status, Illinois residence, household size and monthly income. If the applicant is responding to application questions verbally (over the phone or during an in-person interview), treat the applicant's response as a declaration. To authorize CPE coverage, only a declaration is required: accept the applicant's statement.
Declaration of Illinois Residency
On the Program Request Child Presumptive Eligibility screen in IES Application Registration, review the application for a response to the question regarding Illinois residency. If the applicant failed to answer the question about Illinois residency, contact HFS policy for instructions on completing the Child PE screen.
Declaration of U.S. Citizenship/Satisfactory Immigration Status
On the Program Request Child Presumptive Eligibility screen in IES Application Registration, review the application for responses to the questions regarding U.S. citizenship and immigration status. If the applicant failed to state on the application that the child is either a U.S. citizen or has satisfactory immigration status, check the box in IES Register Program Child Presumptive Eligibility screen for immigration. Checking the box will disqualify the child for CPE. Accept the applicant's statement regarding U.S. citizenship or satisfactory immigration status. For the child's PE determination, do not verify the child's immigration status in SAVE or the child's U.S. citizenship in the electronic clearance from Social Security Administration. If conflicting information is found, contact HFS medical policy for guidance.
Example: Ms. I applies for medical benefits for her son, age 8. Ms. I reports on her application only the items required for a children's PE determination. Ms. I reported that they are Illinois residents, her son is a legal permanent resident, they are a household size of 2 and the monthly income is $300.00 per week. The child has not had presumptive eligibility in past 12 months. Ms. I's son qualifies for child PE.
Example: Ms. E applies for medical benefits for her two children, ages 5 and 14. Ms. E completes the entire application and indicates the 14 year old child is not a U.S. citizen but leaves the response blank regarding the 14 year old's immigration status. The 14 year old child is not eligible for child PE because Ms. E did not declare the child's satisfactory immigration status.
Example: Mr. S applies for medical benefits for his 9 year old daughter. Mr. S reports on his application that his daughter is not a U.S. citizen but has a current visa for Family Unity Beneficiary. Mr. S declares his family are Illinois residents and the household income is $900 per month. His daughter has not received presumptive eligibility in past 12 months. Mr. S's daughter qualifies for child PE.
Declaration of Family Income
(FCRC) Do not verify income before authorizing CPE. The amount entered is based strictly on the applicant's statement.
On the Program Request Child Presumptive Eligibility screen in IES, indicate whether or not the declared gross family income is available and the number of people in the household. Include all children applying as well as their parents and siblings. If a pregnant woman is included in the standard, increase the Number in Standard by the number of babies expected.
Under Declared Income Details, enter the gross income amount in Income Amount and select the frequency from the drop down in Income Frequency. Do not split family income to decide the amount to put in the Income Amount field. For electronic ABE and mail-in applications, enter the amount shown on the application.
- If the family lists a range of income on the application, use the higher amount.
- If the family does not have any income, or does not list any income on the application, do not enter anything in the Income Amount field.
- If the family has multiple sources of income, list each income separately and click Add to add the income to the Declared Income Summary. Each source of income added will be converted to a monthly amount using income averaging.
- If the family indicates on the application that they have income, but fails to put an amount, or puts something other than a dollar amount, in the correct field, the family is not eligible for CPE.
Example: The G family answers yes to the employment question on a mail in application. In the Amount Paid before taxes, they enter "Varies." The family is not eligible for CPE since the family did not declare their income.
Gross family income is used to determine PE eligibility. The system uses regular income-averaging to determine monthly income (i.e., weekly income is multiplied by 4.3). Modified Adjusted Gross Income (MAGI) deductions such as expenses deducted on the federal income tax return are not allowed.
Example: The A family goes to their local FCRC to apply for TANF. Mr. A states that the only family income is his UI of $110 every two weeks. Enter $110 under Income Amount and select biweekly under Income Frequency.
Example: The B family goes to their local FCRC to apply for medical benefits for Mr. B and his fiancé Ms. Z, their child, and Ms. Z's three children from a previous marriage. Ms. Z states that family income is $200 per week from Mr. B's employment and $225 per month in Social Security for each of Ms. Z's children. Under Gross Income, enter $200 and select weekly from the drop down options under Income Frequency; click Add. Then enter $225 under Income Amount and select monthly from the drop down options under Income Frequency; click Add for each child receiving Social Security. IES will calculate the correct amount for each income entered and determine if the income is less than the standard for the household size.
(IES) After the worker has completed the Program Request Child Presumptive Eligibility, IES automatically determines PE eligibility and displays the results in the Program Summary screen.
PE Coverage Within the Last 12 Months
The name of each child under age 19 will appear on the Program Request Child Presumptive Eligibility screen with a box to check if the child has received presumptive eligibility (including MPE) in the past 12 months. This information can be found in MMIS for each person.
(IES) If the child started receiving CPE within the last 12 months (under the same case number or different case number) and the worker indicates that the child did not receive PE within the last 12 months, the system will process the CPE approval incorrectly. Check MMIS carefully and complete the child PE screen in IES correctly.
Authorizing Child PE in the Add Member Driver Flow
When adding a child to an active medical benefits case in IES, child PE will be authorized if eligible in the Program Request Child Presumptive Eligibility while in the Add Member driver flow in Data Collection. Child PE is authorized prior to screening for necessary verifications for ongoing medical coverage.
A child may qualify for child PE during the addition process even if additional verification is needed for on-going eligibility. The Add Member driver flow will bring up a Program Request Child Presumptive Eligibility screen which will authorize the PE coverage prior to the usual Date Collection process. A Verification Checklist (VCL) may be required for additional verification to complete the addition action for regular coverage.
Declared Income
Declared income is the income on file for the case plus any income the child is reported to have. The head of household must declare if the child has income and provide the amount, if any.
Legacy Process
A screen, CAF SCREEN CPE (CHILD PE MEDICAL), appears in AIS in the Intake Screener Subsystem (both regular and mail-in) as well as the Single Contact Interview immediately following the "Cases Have Been Registered" screen. The purpose of this screen is for the worker to enter the information needed for AIS to determine if the child is eligible for PE coverage.
Declared Family Income
(FCRC) Do not verify income before authorizing PE. The amount entered is based strictly on the applicant's statement. Enter on CAF Screen CPE under Gross Income Amount the income that the family declares. Enter the frequency the income is received under the Pay Freq column. Do not split family income to decide the amount to put in the Gross Income Amount field. For mail-in applications, enter the amount shown on the application. If the family lists a range of income on a mail-in application, use the higher amount. If the family does not have any income, or does not list any income on a mail-in application, do not enter anything in the Gross Income Amount column.
However, if the family indicates on a mail-in application that they have income, but fails to put an amount, or puts something other than a dollar amount, in the correct field, the family is not eligible for PE.
Example: The G family answers yes to the employment question on Form 2378KC. In the Amount Paid before taxes, they enter "Varies." The family is not eligible for PE since the family did not declare their income.
Gross family income is used to determine PE eligibility. The system uses regular income-averaging to determine monthly income (i.e., weekly income is multiplied by 4.3). The normal deductions, such as the earned income deduction or child care, are not allowed.
Enter the number of people in the family in the Number in Standard. Include all children applying as well as their parents and siblings. If a pregnant woman is included in the standard, increase the Number in Standard by the number of babies expected.
Example: The A family goes to their local FCRC to apply for TANF. Mr. A states that the only family income is his UI of $110 every two weeks. Enter $110 under Gross Income Amount and 3 under Pay Freq.
Example: The B family goes to their local FCRC to apply for medical benefits for Mr. and Mrs. B, their child, and Mrs. B's three children from a previous marriage. Mrs. B states that family income is $200 per week from Mr. B's job and $500 per month in child support for Mrs. B's children. On the first line under Gross Income, enter $200 and enter 2 under Pay Freq. On the second line enter $500 under Gross Income and 5 under Pay Freq.
(AIS) After the worker has completed the CAF Screen CPE, the system automatically determines PE eligibility and displays the CAF Screen CPE again with the Total Gross Income completed and a message that PE either has or has not been authorized. The screen will automatically print with the Screener CAF. Put it in the case record in NERF Section 1.
PE Coverage Within the Last 12 Months
(FCRC) The name of each child under 19 will appear on the CAF Screen CPE with a field for the worker to indicate if the child started receiving PE in any of the last 12 months. This information can be found on Screen 3 of ACID for each person following a field called PEDTE that is next to the DELDTE. If PE appears in this field, the date that PE started will appear in the PEDTE. Receipt of MPE by a pregnant woman is considered receiving PE.
Example: The C family mails an application to the All Kids Unit for Mary and Susie. The date of application is 12/04/04. The ACID clearance indicates that the C family has applied before. Screen 3 of ACID shows PE for Mary next to the line indicator but does not show PE for Susie. The deletion date for Mary is 05/04. Enter a Y for Mary and an N for Susie.
Example: The D family mails an application to the All Kids Unit for Johnnie. The date of application is 06/01/05. The ACID clearance shows a PE for Johnnie next to the line indicator with a deletion date of 05/04. Enter an N for Johnnie since PE coverage did not start within the last 12 months.
(AIS) If the child started receiving PE within the last 12 months under the same case number and the worker indicates that the child did not receive PE within the last 12 months, the system will be able to detect this and will batch except the PE authorization. If the child started receiving PE coverage within the last 12 months under a difference case number, the system will not be able to detect this and the PE approval will go through. This is why it is important for the worker to look at the ACID clearance carefully.
Worker Has No Knowledge That Citizenship/immigration Requirement Is Not Met
A field, IMG, appears on the CPE screen for each child under 19 with a field for the worker to indicate if the worker knows for a fact that the child does not meet citizenship/immigration status requirements. The field will be set to N since the worker will usually not know at registration that the citizenship/immigration requirement is not met. If the worker does not have proof that the child does not meet citizenship/immigration requirements, do not change the entry on the CAF CPE Screen from N to Y.
Example: The E family mails an application to the local FCRC for their son. They check that their son is not a citizen. The worker has no other knowledge of the child's immigration status. Leave the N in the IMG field since marking on the application that the child is not a citizen is not obvious evidence that the son does not meet citizenship/immigration status requirements.
Example: The F family mails an application to the local FCRC for their daughter. They do not fill out the field regarding their daughter's citizenship status. The worker has no other knowledge of the daughter's citizenship/immigration status. Leave the N in the IMG field since this is not obvious evidence that the daughter does not meet citizenship/immigration status requirements.
Example: The G family mails an application to the local FCRC for their son. They mark that their son is not a citizen. The worker notices on the ACID clearance that a TA 10/TAR B8 authorizing emergency medical coverage for the son was processed last month. Enter a Y in the field since this is obvious evidence that the son does not meet citizenship/immigration status requirements.
