04/07/2022
Summary:
- Illinois Public Aid Code section 305 ILCS 5/5-2.07 was amended to allow an individual who uses Medicaid spenddown to qualify for medical assistance up to six consecutive months to submit medical receipts and bills to meet spenddown before becoming ineligible for medical assistance.
- Changes in the Integrated Eligibility System (IES) have occurred to modify the monthly enrollment review period in order to allow six consecutive months prior to eligibility ending due to unmet spenddown status for an AABD Community spenddown Eligibility Determination Group (EDG).
This manual release provides guidance related to a change in the allowable enrollment time period for medical assistance in AABD Community spenddown prior to eligibility ending due to unmet status. An individual's AABD Community spenddown EDG will remain open in unmet status for six consecutive months. Previously, an AABD Community spenddown EDG was closed due to three months in unmet spenddown status.
AABD Community Spenddown Enrollment Period Updates
The enrollment period for an AABD Community spenddown EDG is twelve calendar months. An individual's AABD Community spenddown EDG is automatically reviewed monthly beginning in the seventh month of the enrollment period to determine if spenddown was met in one of the last six months at the time of review (including the month of review). The AABD Community spenddown EDG will close when zero out of six months have been met; unless the individual is enrolled in the Pay-In Spenddown program, on a waiting list, or would be on a waiting list to receive a transplant if he or she had a source of payment. The EDG closure will not occur if at least one out of the six months is met.
The six month timeline counter restarts after spenddown is met for a month.
There is not a set enrollment period for LTC, SLP, Family Health (child), Family Health (pregnant), and DOA spenddown EDGs. These EDGs remain open and are not automatically closed.
IES Updates
IES programming has been modified to allow an AABD Community spenddown EDG to remain open for six consecutive months in unmet status rather than three months. IES will close an AABD Community spenddown EDG after nine months when spenddown has not been met in any one of the six consecutive months.
Example: A customer is enrolled in AABD Community spenddown in met status for the month of December and unmet status ongoing beginning in the month of January. In July a review occurs to determine if spenddown was met in the last six months (January, February, March, April, May, June). The customer has not met spenddown in at least one of the six months reviewed. IES closes the customer's AABD Community spenddown EDG in September, effective October.
MANUAL REVISIONS
[signed copy on file]
Grace B. Hou
Secretary, Illinois Department of Human Services
Theresa Eagleson
Director, Illinois Department of Healthcare and Family Services
Forms revised
