PM 18-05-01: Continuous Medical Eligibility for Persons Under Age 19

WAG 18-05-01

IES Phase 2

Once determined eligible, a person under age 19 is eligible for medical benefits for 12 months. The 12 month continuous medical eligibility period begins with the first month of their certification period. In addition to the 12 month certification period, a child qualifies for continuous eligibility from the first back date month in which they qualify for All Kids Assist or AABD medical.

This applies to All Kids Assist as well as children enrolled in AABD medical. Under continuous eligibility, a child's medical benefits cannot be terminated or moved to a higher cost medical program due to a change in income or household size during the certification period. However, a child may be redetermined and assigned a new certification period if the child qualifies for the same level of benefits, or the change results in a lessor cost medical program.

Continuous medical eligibility applies to persons under 19, including a caretaker relative and their spouse, if under age 19. It does not apply to persons determined eligible for medical benefits as:

  • spenddown met; or
  • emergency medical for noncitizens; or
  • PE; or
  • MPE.

Once a person under 19 is determined eligible for medical benefits (except for the 4 situations listed above), they remain eligible regardless of changes in income or living arrangement for 12 months beginning with the first month of their certification period. They are eligible unless they:

  • reach age 19;
  • move out of the State of Illinois;
  • were incorrectly determined eligible in the first place;
  • are a parent and refuse to cooperate with child support/medical support rights;
  • fail to cooperate with the SSN requirement; or
  • request cancellation.

When a child enters a jail or juvenile detention facility, they only qualify for hospital and professional services rendered during the hospital stay.  Do not terminate a child's medical benefit because they are detained in a jail or juvenile detention facility. Refer to PM 03-23-01.

Note: Continuous Eligibility does not apply when the Head of Household is reported deceased by an acceptable type of verification.

Legacy System Prior to IES Phase 2 Implementation

The continuous Medicaid eligibility period begins with the month in which the eligibility determination is made (unless the family is only eligible for spenddown) and continues for 12 months after that month, for a total of 13 months.