- Per Code of Federal Regulations (CFR) section 435.404 Applicant's Choice of Category, the agency must allow an individual who would be eligible under more than one category to have their eligibility determined for the category of their choice.
- Effective 07/29/2021, a new question in Application for Benefits Eligibility (ABE) and Integrated Eligibility System (IES) will be available to capture an individual's choice of eligibility category.
- Changes to the medical eligibility determination sequence in Integrated Eligibility System (IES) will occur based on an individual's choice of eligibility category.
This manual release provides guidance related to implementation of the Applicant's Choice of Category federal requirement which mandates that an individual eligible for more than one medical benefit program have an opportunity to choose an eligibility category.
Eligibility Determination Updates
The medical benefit choice question will allow applicants or customers to select if they would prefer the following:
- Aid to the Aged, Blind, and Disabled (AABD);
- Family Care or ACA;
- No Preference.
IES will consider the preference selection as a priority over other medical benefit program EDGs if the individual is eligible for more than one type of medical program. If No Preference is selected or if the individual is not eligible for their preferred medical program, IES will progress the EDG to the most beneficial medical program for the eligible individual.
During periods of continuous eligibility for children and pregnant women, medical program changes will not occur based on a medical eligibility category preference; existing coverage will continue until redetermination.
Only a future medical benefit month may be changed due to a medical benefit program request for an individual currently receiving medical benefits. A previously certified month should not be changed.
Beginning 07/29/2021, ABE and Manage My Case (MMC) will display the following new question on the Individual screen to confirm an applicant's medical benefit choice when applying for benefits.
When the 'Question Mark' hover text is selected a table is displayed to provide a summary of the medical program options.
|Aid to Aged, Blind and Disabled (AABD) Medical
||Covers seniors, persons who are blind and persons with disabilities with income up to 100% of the federal poverty level (FPL) and no more than $2,000 of non-exempt resources (one person). If income or resources are over the FPL limit, the person may be eligible for spenddown. Please see HFS 591SP Medicaid Spend-down for more info on AABD spenddown.
||Covers children 18 years of age and younger, and their parents or caretaker relatives. To be eligible, children must live in families with countable family income within 318 % of the federal poverty level (FPL). The parents/caretaker relatives are eligible for coverage if the countable income is up to 138% FPL.
||Covers adults 19-64, who are not parents or caretakers of minor children, with income up to 138% of the federal poverty level.
NOTE: All the above mentioned programs provide the same medical coverage.
The Program Request - Individuals page in IES will be updated to include the new medical benefit choice question and the requested program begin date. The field associated with 'If this person is eligible for more than one type of medical program, what would be the preference?' will be auto populated to display Aid to the Aged, Blind, and Disabled (AABD), Family Care or ACA, or No Preference based on the selection provided in ABE. The Requested Program Begin Date field will also be auto populated from ABE. In addition, a worker may change these fields based on a request received from the individual.
[signed copy on file]
Grace B. Hou
Secretary, Illinois Department of Human Services
Director, Illinois Department of Healthcare and Family Services
- Form 243
- Form 243A-C
- Form 2378ABE
- Form 2378B