- Clarifies Medicaid policy for Department of Children and Family Services (DCFS) medical benefits and adds a new section for DCFS medical benefits to the Cash, SNAP and Medical policy manual;
- Explains that medical coverage is authorized for DCFS children through an interagency agreement between HFS and DCFS;
- Publishes information about system authorizations;
- Adds instructions for authorizing and maintaining DCFS cases in the Integrated Eligibility System (IES) Application/Registration system;
- Clarifies procedures for DCFS staff to determine Medicaid or state funded medical eligibility for each child/youth who receives medical assistance; and
- Adds procedures for coordinating the medical benefits between DCFS and Department of Human Services (DHS) Family Community Resource Centers (FCRCs) and Healthcare and Family Services (HFS).
This manual release provides policy and procedures for DCFS medical benefits for cases known in the MMIS system as category 98. DCFS administers Foster Care, Adoption Assistance and subsidized guardianship (KinGap) services provided under Title IV-E of the Social Security Act. Procedural instructions in this release are primarily for DCFS staff who are approving and maintaining medical cases.
How to Identify a DCFS Case in IES
DCFS medical benefits are authorized in the DCFS office using the IES Application/ Registration module, this access is restricted to DCFS staff users. All DCFS Cases begin with "T"; the DCFS cases are created and maintained in IES through Application Registration only, these are not "Pending Applications". To verify a case is assigned to DCFS, select either the:
Individual Inquiry page
- Enter the application number, social security number or the client's name;
- Select search;
- scroll to the Search Results section at the bottom of the page and select the desired Application number; and
- scroll to the Application Assignment Details section, under the Office column, the assigned office name will be displayed.
Search Application page
- Enter the application number, social security number or the client's name;
- select search; and
- review the office name in the "Application Search Results" field.
Note: DCFS staff will be taking the following actions described in this manual release.
Eligibility for DCFS Medical
Through an interagency agreement, children/youth who receive DCFS services also receive medical benefits (category 98). IES sends Medical eligibility to the Recipient Database in MMIS through a daily interfaceDCFS Categories
DCFS medical groups fall into five categories:
- Foster Care;
- KinGap (formerly subsidized guardianship waiver);
- Adoption Assistance;
- Child of a Youth in Care (child of the teen parent who receives Foster Care);
- Child/youth released by Department of Juvenile Justice to a Foster Care setting in the community. These cases are referred to by DCFS as Department of Corrections (DOC) cases.
Youth age 21 and older may receive College or University Scholarship (CUS) with Foster Care, KinGap or adoption assistance and continue to receive medical benefits. Medical coverage authorized to CUS is state funded.
A description of the authorization of DCFS services process, performed by DCFS Staff, appears in the new PM 06-27-00. A description of how DCFS medical cases look in IES appears in WAG 06-27-00.
DCFS staff authorize medical coverage to children/youth for whom DCFS provides services from one of the five categories listed above. Most DCFS children/youth are Medicaid eligible; therefore, the cost of their medical care is eligible for Federal Financial Participation (FFP). DCFS staff determine Medicaid eligibility initially, annually at redetermination and at the point the DCFS services end for a child/youth.Children/youth who are found to be ineligible under Medicaid receive state funded medical coverage.
Eligibility Under Title IV-E
Children/youth determined by DCFS to be eligible under Title IV-E of the Social Security Act are deemed Medicaid eligible. Children born to a youth in care (formerly known as child of ward) are deemed Medicaid eligible because the teen parent received DCFS Medicaid at the time of birth.
Opening a New DCFS Case
The medical coverage start date begins on the day in which the child/youth is taken into protective custody (removed from the home). Confirm the date in Bluezone/PACIS MMIS screen. The date shown in IES/Inquire/Individual is the transaction date, not the date the child was removed from the home.
Effective Date of Change for Active DCFS Cases
Enter the effective date of change in the Eligibility Begin Date field on the DCFS Eligibility Details screen in IES. IES edits will not permit a future date. Do not enter a date in the End Eligibility Date field. Refer to the table in WAG 06-27-01-c to determine when to enter an Effective Begin Date.
Example: Ben is in Foster Care since January 3rd. On March 22nd, Ben's status changes to KinGap. In the DCFS Eligibility Details screen, update the DCFS category to KinGap and enter the Begin Eligibility Date for March 22nd. Do not enter an End Eligibility Date.
Example: Daph is in Foster Care since June 15th. On November 18th, Daph's status changes to KinGap and an out of state placement, Interstate Compact on Adoption and Medical Assistance (ICAMA). Daph is living in Hawaii with her grandmother. In the IES DCFS Eligibility Details screen, DCFS staff update the DCFS category to KinGap, enter the Begin Eligibility Date for November 18th and enter Hawaii as the state of residence and update the Medicaid question to No.
Example: Jon is in Foster Care since April 10th. His date of birth was originally entered as December 14th. The correct date of birth is December 12th. An Effective Begin Date is not required for this change.
Issuance of Temporary Identification Numbers
Temporary medical coverage may be authorized as soon as a child is taken into protective custody. The DCFS worker contacts the DCFS Medical Card Hotline (or the Placement Clearance Desk during non-work hours) to obtain a Temporary Identification Number for use by the DCFS Managed Care Provider. The Managed Care Provider will coordinate with HFS to issue a medical Recipient Identification Number (RIN).
Example: Annie is taken into protective custody on December 1. Annie has never been issued a RIN in any other case. The investigator obtains a temporary ID number for DCFS managed care from the Placement Clearance Desk. The DCFS Technical Support Unit opens a DCFS Foster Care case in Application/Registration and Annie is assigned a new RIN.
Example: Bing was taken into protective custody on August 8. A temporary ID number was assigned to Bing and a DCFS Foster Care case was opened. Later, it was confirmed that Bing was on All Kids Assist at the time he was taken into protective custody. On coordinating with the DCFS Managed Care Provider, DCFS Caseworker sets up a new Foster Care case using the All Kids Assist RIN.
When a child/youth is adopted, the adoptive parents may change the child's name and possibly the child's Social Security Number. Sometimes the change in SSN may happen weeks or months after the adoption. When reported that the SSN has changed, review SOLQ to see if the new SSN can be verified. For privacy purposes, end the child's case with the original RIN and open a case with the new RIN. If the SSN cannot be verified through SOLQ, set a control for 30 days to review.
DCFS closes the existing DCFS case and opens an adoption assistance case. Make sure there is no gap in coverage from the old case to the new case.
Example: Clem is in Foster Care since August 14th. On October 5th, Clem's status changes to Adoption Assistance. The DCFS worker closes the Foster Care case and opens an adoption assistance case. Enter the Begin Eligibility Date as October 5. Do not enter an End Eligibility Date.
Example: Isabelle was previously in Foster Care and was adopted on March 6 and her adoptive parents filed with Social Security for a new SSN. Isabelle had a RIN in Foster Care, but that RIN is not associated to her adoption case. DCFS Caseworker assigns Isabelle a new RIN in IES under her new name and new SSN. The worker verifies the new SSN through SOLQ. DCFS closes the Foster Care case and opens an adoption assistance case. Enter the date the adoption was finalized in the Begin Eligibility Date field in IES for the new case.
Financial Factors of Medicaid Eligibility
Disregard the income and resources of a DCFS child/youth. Children receiving DCFS services under title IV-E of the Social Security Act are deemed eligible for Medicaid without regard to income and resources. Financial eligibility for DCFS children is addressed in PM 06-27-03.
Nonfinancial Factors of Medicaid Eligibility
The determination of nonfinancial factors of Medicaid eligibility for DCFS children is generally the same as for children receiving All Kids Assist except as specified below and in PM 06-27-02 including the subsections. For children who do not meet Medicaid requirements, authorize state funded medical coverage. Verify non-financial factors of eligibility using IES Data Exchange or through PACIS interfaces as needed.
The Title XIX Medicaid State Plan provides for Medicaid eligibility for children/youth up to age 21 receiving services through DCFS. Verify age electronically using the clearance results in IES Data Exchange or through the PACIS interfaces as needed. DCFS youth age 21 and older are non-Medicaid and receive state funded medical coverage.
U.S. Citizenship/Immigration Status
DCFS children/youth must meet the citizenship or immigration requirements listed in PM 03-01-00 to qualify for Medicaid funded medical coverage. Verify U.S. citizenship or immigration status using IES Data Exchange or through the PACIS interfaces as needed.
Social Security Number (SSN)
DCFS children/youth must meet the SSN requirement as described in PM 03-11-00 to qualify for Medicaid funded medical coverage. Verify the SSN using the IES Data Exchange or through the PACIS interfaces as needed.
DCFS children/youth must meet the residency requirement as described in PM 03-02-00 to qualify for Medicaid funded medical coverage. DCFS' records showing a placement in Illinois meets the verification of residency requirements. Children/youth in out-of-state placements are not Medicaid eligible but continue to receive state funded HFS medical coverage until medical coverage starts in the other state.
Illinois is a member of the Association of Administrators of the Interstate Compact on Adoption and Medical Assistance (AAICAMA). Illinois adopted the compact to offer Medicaid to children/youth receiving Title IV-E services from other states. It provides for Illinois children to be placed out of state until Medicaid in the placement state begins. DCFS makes out-of-state placements for children/youth when appropriate. This arrangement is often referred to as reciprocity.
Children receiving out of state IV-E services (Foster Care, subsidized guardianship or adoption assistance) and residing in Illinois are maintained by staff in the DHS Bureau of Local Office Transactions & Support Service in Central Office 238.
A redetermination of Medicaid eligibility is required once every 12 months. DCFS staff complete redeterminations. Redeterminations are addressed in PM 06-27-01-c.
Ending DCFS Eligibility
When DCFS services end, the DCFS worker enters the actual end date of medical eligibility in IES on the DCFS Eligibility Details screen. Follow the Authorization Schedule used in the IES system for ending medical coverage. If the transaction date is after the 15th of the month, end eligibility at the end of the following month. See PM 06-27-05 for more information.
Children/youth whose DCFS services have ended are entitled to continuous eligibility (CE) of their medical coverage beginning with the month following the last medical determination before their DCFS services ended until they reach their 19th birthday or they receive 12 months of coverage whichever is earlier as described in PM 18-05-01.
Example 8: Enid, age 16, is in Foster Care. Enid's Foster Care ends November 30, per a court order. The last medical redetermination was in November of this year. Enid qualifies for continuous eligibility. The End Eligibility End Date is November 30 of next year.
Example 9: Zach, age 18, is in KinGap. Zach's birthday is May 15th. KinGap ends December 7. The last medical redetermination was in September of this year. Zach qualifies for continuous eligibility through the month of his 19th birthday. The End Eligibility End Date is May 30 of next year.
Example 10: Alicia, age 18, is in Adoption Assistance. Alicia's birthday is February 1. Adoption Assistance ends October 13. The last medical redetermination was in July of this year. Alicia qualifies for continuous eligibility through the month before her 19th birthday. The End Eligibility Date is January 31 of next year.
Example 11: Garrett, age 11, is in Foster Care. Garrett runs away from the foster home and is found in the home of his parent (unauthorized home of parent). Foster care ends June 6. The last medical determination was in June of this year. Garrett qualifies for continuous eligibility. The End Eligibility Date is June 30 of next year.
Reopening a Closed DCFS Case in IES
To reopen an inactive case in IES, go to the DCFS Eligibility Details screen. Enter the new information including the reopen date in the Begin Eligibility Date field and remove the existing end date from the End Eligibility Date field. PM 06-27-01-a addresses reopened DCFS cases in IES.
Do not create a new case for a child/youth who has an inactive DCFS case.
DCFS Maintains Medical Coverage for Children/Youth Receiving DCFS Services
TANF/AABD Cash Assistance or Medical Benefits
Children/youth on an active DCFS case may not receive or continue to receive DHS cash assistance or medical benefits. The Family Community Resource Center (FCRC) or All Kids Unit must remove the child/youth from the cash assistance or medical benefits case as soon as possible.
A child/youth's foster or adoptive family may qualify for SNAP. Refer to PM 08-04-04-e for the Family Community Resource Center's (FCRC) budgeting of foster care payments for SNAP.
Once a DCFS medical case is established in IES for child/youth, cash or other medical benefits cannot be authorized for a child under age 19 in a separate case until DCFS staff closes the DCFS medical case.
When a child/youth who is active on a case in the FCRC or All Kids unit is taken into protective custody, DCFS authorizes medical benefits right away. A task is created in IES for the FCRC or All Kids Unit to review their case and follow up as needed.
If a DCFS youth age 19 or older submits an application for cash or medical assistance, IES edits will permit registration and processing of the application. The youth may qualify for Former Foster Care (PM 06-28-00) or ACA Adult (PM 06-25-00).
If there is no end date entered in End Eligibility Date in the DCFS Application/Registration subsystem, then the DCFS case is active. DCFS caseworker must close their case by entering an End Eligibility Date in the DCFS Application Registration Subsystem.
IES prevents DHS/HFS staff from putting a child receiving DCFS authorized continuous eligibility into a cash or All Kids medical case.
Electronic Document Management (EDM) in IES
When a child/youth is removed from the home and the child/youth is receiving cash, medical or SNAP benefits on a case active in a Family Community Resource Center (FCRC) or in the All Kids Unit, IES sets a task, "Child Taken into Protective Custody" for the DHS/HFS worker to follow up once the child's DCFS medical case is opened.
See WAG 06-27-04 for a list of actions required by DHS and HFS caseworkers when a child or youth is removed from the home.
[signed copy on file]
Director, Illinois Department of HealthCare and Family Services
Grace B. Hou
Secretary, Illinois Department of Human Services