PM-06-27-05 Ending Medical Coverage for DCFS Youth

WAG 06-27-05

Before canceling medical coverage, determine if the child/youth qualifies for continuous eligibility (DCFS extended medical).  Once an individual under age 19 is determined eligible for DCFS medical benefits, they are eligible for DCFS medical benefits, regardless of changes in income or living arrangement.

Continuous Eligibility (DCFS Extended Medical)

The continuous medical eligibility period begins with the month in which the last determination for Medicaid or state funded eligibility was completed and continues for up to 12 months. Children/youth are eligible for continuous eligibility regardless of changes in income or living arrangement unless or until one of the following occurs.  The child/youth:

• Reaches age 19;
• Moves out of the state of Illinois;
• Was incorrectly determined eligible; or
• Requests cancellation.

A child/youth does not qualify for continuous eligibility for a month beyond the month he or she turns age 19. 

• When the child/youth has a birthday on the first of the month, the continuous eligibility ends on the last day of the previous month. 
• When the child/youth has a birthday on the 2nd day of the month or later, continuous eligibility ends on the last day of the month of birth. 

IES prevents DHS/HFS staff from putting a child receiving DCFS authorized continuous eligibility into a cash or All Kids medical case. Coordinate with the DHS/HFS office to end the CE early to permit the child to be added to the other cash or medical benefit.

When a child/youth enters a jail or juvenile detention facility, their medical benefits are limited to hospital and professional services rendered during the hospital stay.  Do not cancel a child's continuous eligibility medical benefit because they are detained in a jail or juvenile detention facility. Refer to PM 03-23-01.

IES

End Medical Coverage for a DCFS Child/Youth

On the DCFS Eligibility Details screen in IES, enter an Eligibility End Date.  Entry of an Eligibility End Date cancels the DCFS medical case and releases the child/youth in IES so that DHS or HFS caseworkers may take actions on the individual such as an application for assistance or a request to be added to other assistance. 

Determine if the child/youth qualifies for continuous eligibility.  Determine the month and year of the last medical redetermination. Enter the Eligibility End Date as the last day of the month, 12 months from the month following the last medical redetermination or when the child reaches age 19, see PM 18-05-01. If the child/youth is not eligible for continuous eligibility, use the table below to determine the Eligibility End Date. 

In IES, the 15th of the month is the last day to process changes on a case for the next calendar month. However, in the Application-Registration module in IES, there is no automated processing schedule controlling the effective date coverage starts, changes or ends. Determine the end date of coverage using the table below.