PM 19-02-03-b: Proving Eligibility

WAG 19-02-03-b

IES Phase 2 Process

Upon implementation of the Integrated Eligibility System (IES) phase 2, the process for completing a redetermination is changed. The Medical REDE process is described in PM 19-02-04. 

New Manual MaterialFor the AABD Cash REDE, verification of the following is required:

  • current income;
  • current resources;
  • disability for AABD Cash EDG (disability), blindness for AABD Cash EDG (blindness) or if there is a CAU reexamination date or they no longer receive SSI or SSA; and
  • verify deductible expenses if questionable and if allowing the expense would result in a deduction.

New Manual MaterialSee PM 19-02-03-a for policy to process an AABD Cash Rede.

Legacy Process

Updated with Policy Memo, Changes to the Illinois Medicaid Redetermination Project (IMRP) revised

The REDE form is sent to all medical only AABD customers by Maximus, an external vendor and part of the Illinois Medicaid Redetermination Project (IMRP), when the redetermination is due. 

Never require a person to come to the FCRC to complete a medical REDE.

Explain the Health Insurance Premium Payment (HIPP) Program to customers if they have high-cost medical conditions and have health insurance available to them.

At REDE verify the following for all cases:

  • Documentation of citizenship and identity for U.S. citizens if not yet documented; and
  • Illinois residency for medical-only customers who live in the community and are not centrally redetermined (see WAG 19-02-03-b); and
  • Support paid as a deduction from income; and 
  • TPL information (complete the necessary forms).

For noncitizens, USCIS status must be verified through SAVE (Systematic Alien Verification of Entitlements), if the status is subject to change or proof through SAVE has not already been obtained.

For U.S. citizens, documentation of citizenship and identity is required (see PM 03-01-01). Complete an SSA citizenship inquiry for each person for whom citizenship and identity has not yet been documented (see PM 22-14-03-e). If citizenship and identity cannot be confirmed via the SSA inquiry, send the customer a request (Form 1721 with Form 3859A-Help Sheet for Citizenship & Identity Documentation) to provide documentation within 3 months. If otherwise eligible, process the REDE while documentation is pending and set a control or flag the case for follow up.

If the required documents are not provided by the end of the 3-month period, cancel or delete the person from medical assistance unless the person is:

  • a child under age 19 (enter code 47 in Item 74); or
  • an adult who had an active case AND has been continuously living in a nursing home, CILA, or SLF since 11/30/11 or earlier (enter code 47 in Item 74).

Note: Children may receive Home and Community Based Waiver Care (HCBC) Services through age 21 (Item 80 contains code 335). Contact HFS Medical Eligibility and Special Programs ("Policy") for guidance prior to taking negative action on an HCBC case.

Simplified Processing for Determining Income and Resource Eligibility

Simplified Processing does not apply to TANF and/or AABD cash cases.  This policy applies to Community Medical and Long Term Supports and Services (LTSS) clients.

  • Accept receipt of Supplemental Security Income (SSI) as verification of financial eligibility for both income and resources for individuals who are receiving SSI.
  • Accept the individual's current written statement declaring that their resources are below the resource standard for the program, unless questionable, when their verified income is at or below 100% Federal Poverty Level (FPL).
  • Accept information reported on a redetermination form as a current written statement of resources.
  • Verify resource transfers for all individuals receiving (LTSS).

For Cases not eligible for Simplified Processing

Verification required at REDE is:

  • current income;
  • current resources;
  • disability for 93 cases and blindness for 92 cases, if there is a CAU reexam date or they no longer receive SSI or SSA

REDE for LTSS

For NH, SLF, and Medical customers receiving DoA services, apply policy for reported resource transfers by following PM 07-02-20. To determine the application of nonexempt income, see PM 15-04-04.

For NH, SLF, and Medical customers receiving DoA services, verify the income of the community spouse or dependent family members to determine if the customer's income may be diverted to meet the needs of those family members in the following situations only:

  • The customer requests his or her income be diverted to the community spouse or dependent family members and no diversion of income is currently being made; or
  • The customer requests to give the January Social Security Cost of Living Adjustment (COLA) to the community spouse or dependent family members; or
  • A change in income is reported or a recalculation of the diverted income is requested.

For customers in nursing homes, a review of ongoing eligibility includes a review of each customer's personal funds and room and board accounts.