WAG 17-02-05-a: Backdating Medical (All Programs)

PM 17-02-05-a

See IES Job Aid -  Add/Remove Backdated Medical

For special guidance for backdating medical benefit, review the following Medical Morsel:

(FCRC) Determine eligibility for medical backdating for each specific month in the 3-month backdate period.

NOTE: Do not approve medical backdating for any month before the month a person meets Illinois residency requirements.

The way medical backdate eligibility is approved depends on:

NOTE: Also consider the transfer of resources when determining beginning eligibility for medical long term care payments (see WAG 07-02-20).

NOTE: These conditions apply to TANF Cash, FamilyCare Assist, All Kids Assist, and AABD applications. Approval depends on meeting nonfinancial factors.

View backdated months as consecutive if the backdated month(s) are immediately before the month in which the application was filed. This means:

For AABD:

For TANF Cash, FamilyCare Assist, and All Kids Assist:

Medical Backdating for Cash and Regular Cases

Medical Backdating for Consecutive Months

(FCRC) If a person(s) is eligible for medical backdating on AABD Cash, TANF Cash, FamilyCare Assist, All Kids Assist, or AABD Medical case, and the backdate months are consecutive:

Approve the backdating in IES.

(System) If not suppressed, sends Form 360C which:

Medical Backdating for Non-Consecutive Months

(FCRC) For AABD/TANF Cash or MANG cases, when eligibility for medical backdating is approved for a month(s) that is not consecutive:

Complete and send the Request for Correction/Addition to MMIS Medical Eligibility File (Form 2958), to the Exception Processing Unit (EPU) in Springfield.

For each month, enter the beginning and ending medical eligibility date.

NOTE: Form 2958 requests approval of medical coverage for the non consecutive month(s). The MMIS Medical Eligibility File cannot be updated via FCRC computer entry when a backdated month is a non-consecutive month. EPU performs this function.

(System) When not coded to suppress, sends the Notice of Decision on Application for Cash, Medical, and/or SNAP (Form 360C), and advises the person about:

• • which non-consecutive backdate month(s) was approved for medical backdating; and
  • which month(s) was not approved for medical backdating and the reason for ineligibility.
• Example: The person files an application for AABD cash and medical benefits on 09/12/2021. The person requested medical backdating for the months of June, July, and August. Cash benefits are approved and start on 10/12/2021.
• A determination of eligibility was made for the 3 backdate months as follows:
  • August - eligible;
  • July - not eligible (countable assets over the limit);
  • June - eligible.
• 
• To process medical coverage for June (an eligible non-consecutive month), the FCRC sends Form 2958 to the Exception Processing Unit in Springfield. Form 2958 requests medical backdating and updating the MMIS Medical Eligibility File for the June calendar month (06/01/12 through 06/30/12).
• 
• Form 360C advises the person of the eligible medical backdate months (08/12 and 06/12), and the month the person was found ineligible for medical backdating (07/12). Form 360C also gives the reason why the person was ineligible for medical backdating in 07/12.
• 

Spenddown Backdating for Cash Cases (AABD, TANF)

(FCRC) Complete and send Form 2958 to the Exception Processing Unit (EPU) in Springfield when:

Enter the following information on Form 2958:

NOTE: Do not request approval for medical backdating for any spenddown month(s) unless the spenddown is met.

(System) When coded not to suppress, sends Form 360C for:

If medical eligibility is backdated for an AABD or TANF Cash case and at least one of the backdate months is a spenddown month, Form 360C:

(FCRC) To notify the person of medical backdating when one of the months is spenddown, complete and send the applicant the Backdate Supplement To Notice of Decision on Application for Assistance Grant (Form 360B).

NOTE: Do not send Form 360B when the Form 360 series is sent instead of the centrally generated Form 360C. In this situation, complete subsection Medical Backdate (Form 360F), to notify the person of their eligibility for medical backdating.

Follow these steps when using Form 360B:

Approving Medical Backdating Under a Different Category

For MANG, when the original application is approved, enter information on medical eligibility for the backdate period in the proper section on the Notice of Decision on Application for Medical Assistance - MANG Non Spenddown (Form 458).