09/24/13
Supplements Policy Memorandum Illinois Medicaid Redetermination Project dated 2/13/13.
Summary:
- SSI cases that are centrally redetermined will not be contacted by the Illinois Medicaid Redetermination Project (IMRP) unless electronic information indicates a likelihood of ineligibility;
- Redetermination forms will no longer be mailed for Medical Extension cases;
- Redeterminations for Medical Extension cases will be handled the same as other Family Health Plan (FHP) cases.
AABD Central Redeterminations
The central redetermination process will continue for AABD cases with SSI as described in WAG 19-02-03. The Illinois Medicaid Redetermination Project (IMRP) will review electronic information received on these cases. SSI cases will only be contacted by the IMRP if electronic information indicates a likelihood of ineligibility.
Unless customer contact is necessary, Maximus will review the electronic information and recommend "Continue". The Family Community Resource Center (FCRC) caseworker can mark "Continue" for the state determination. If the case meets one of the exclusion reasons in WAG 22-14-03-b, the FCRC worker must obtain additional verification to complete the redetermination, if necessary.
Medical Extension Cases
Paper redetermination forms will no longer be mailed to Medical Extension cases. These cases are handled by the Department of Human Services Medical Extension Unit in Springfield. Do not require a Medical Extension case to complete a paper redetermination form. Redeterminations for Medical Extension cases will be handled the same as other Family Health Plan (FHP) cases.
During the transition, if a customer cooperates with IMRP and necessary information is obtained either electronically or from the customer to show ongoing eligibility, continue medical coverage. If the customer does return a paper redetermination form to the central unit, use the information provided by the customer and the information provided by IMRP to determine eligibility. If the customer failed to cooperate with IMRP or the case was not reviewed by IMRP and the customer failed to provide the paper redetermination, the case is ineligible.
[Signed copy on file]
Michelle R. B. Saddler
Secretary, Illinois Department of Human Services
Julie Hamos
Director, Illinois Department of Healthcare and Family Services
