MR #20.03: Medical Coverage for IDOC Inmates & Misc. Updates

Healthcare and Family Services Logo Illinois Department of Human Services Logo

01/22/2020

Summary

Policy is updated for individuals who are requesting or receiving medical benefits and are confined to an Illinois Department of Corrections (IDOC) facility.
Applications for incarcerated individuals may be filed for one of two reasons: the individual is applying for medical benefits in anticipation of being released from the IDOC facility; or the individual received inpatient hospital services.
There is a two-step process requiring a determination of eligibility at application followed by case updates upon release of the individual based on address and living arrangement.
For inmates in an Illinois county jail, this release removes the restriction on the number of days in advance of the anticipated release date that an application may be filed.
Individuals confined to a federal prison are not eligible for Healthcare and Family Services (HFS) medical benefits.
Miscellaneous updates include changes in terminology for DCFS wards; adds information about the offices processing long term care (LTC) and supportive living program (SLP) applications; and adds a table to WAG 25 about which offices certify and maintain for which programs.

Inmates Anticipating Release from IDOC
1. Step 1 Processing the Application
  1. Address
  2. Clearance Results
    1. Inmate Included on Another Pending Application
    2. Inmate Included on an Active Case
2. Step 2 Following Up: Release to the Community
Inmates Apply for Medical After an Inpatient Hospital Stay
1. Active Cases-Individual Goes to Prison
Immediate Access to Medical Coverage
Individuals in an Illinois County Jail
Miscellaneous Changes
Manual Revisions
1. Forms referenced:

Medical coverage for IDOC inmates is an HFS agency initiative implemented to ensure inmates who have high risk medical or behavioral health conditions receive medical coverage upon release from an IDOC facility.

Effective immediately, do not deny or cancel medical benefits for an individual solely due to being incarcerated in an IDOC facility. For individuals receiving SNAP or cash assistance, follow policy described in PM 03-10-01 and PM 03-23-01.

Full medical benefits are automatically restricted within a week of the individual being approved for medical benefits or upon being admitted to an IDOC corrections facility. Full medical benefits are automatically restored within a week of the individual being released into the community. See MR #17.07 Restricting Medical Benefits for Incarcerated Individuals for more information.

Individuals confined to a federal prison are not eligible for HFS medical benefits. Click here (pdf) for a list of IDOC facilities and federal facilities located in Illinois.

Inmates Anticipating Release from IDOC

Step 1 Processing the Application

If the applicant is currently in an IDOC facility, the applicant may apply for medical benefits in advance of the scheduled release date. The inmate is responsible for responding to all correspondence relating to the pending application and, subsequently, the active case.

Applications from IDOC inmates may be processed by a Family Community Resource Center (FCRC) or the All Kids Unit.

When the application is received, determine eligibility according to existing policy. While most inmates will qualify for ACA Adult, it is possible that some may qualify for:

AABD if disabled, age 65 or older or receiving Medicare;
Moms & Babies if pregnant;
All Kids Assist, Share or Premium Levels 1 or 2; or
Former Foster Care if they received DCFS foster care and are under age 26. For more information on Former Foster Care eligibility, see manual release MR 17.18 Former Foster Care Medical Benefits.

Reminder: For AABD, refer to PM 02-07-03-i for guidance on simplified processing. Send Form 267/VCL and Form 2378DR Declaration of Resource Information to inmates who are age 65 or older or are receiving Medicare if needed.

Because the inmate may still be living in the corrections facility at the time of application, enter the following into IES:

The address of the IDOC facility where the inmate lives;
do not request proof of Illinois residence; the inmate is confined in an Illinois corrections facility;
household size is 1;
for MAGI, use relationship rules if tax filer information is unknown;
count only the inmate's income (and resources if AABD eligible-review simplified processing in PM 02-07-03-i); and
for the initial determination of eligibility, do not consider the family income or the inmate's plans to reunite with family.

Upon approval of the application, IES generates Form 360C Notice of Decision to the address of the IDOC facility entered in IES.

Within a week of the certification for approval in IES, the HFS automated process will restrict the IDOC inmate's medical coverage in MMIS as described in PM 20-02-03.

Address

At registration, enter the address of the IDOC facility where the individual currently lives. Do not enter the community address on the case until the individual is released and actually living in the community.

Clearance Results

Inmate Included on Another Pending Application

If the clearances reveal that the inmate on the IDOC application is included in another pending application for medical benefits, remove the inmate from the pending application and proceed with the IDOC application.

Inmate Included on an Active Case

If the inmate is active on another case, refer to the table below for the action required. Some of the actions described below may require follow up with another office (other FCRCs, All Kids Unit or Health Benefits for Workers with Disabilities (HBWD)/Veterans Care). Work with the other offices as needed to provide the appropriate follow up.

When an inmate is requesting medical benefits, take the action below to update the case as needed.

Living Arrangement on an Active Case	Worker Action Required
Inmate is the only active individual on the case	Change the address on the active case to the IDOC facility and deny the IDOC application. A central notice Form 360C will be generated.
Inmate is active along with other household members	Split the case in IES so the inmate is on a separate case from the other household members and deny the IDOC application. As long as the applicant is confined to the IDOC facility, the individual's presence in the household cannot be included in the EDGs of the other household members.
Inmate is the head of household (HoH) on the active case with other household members	If another individual can be established as Head of Household, close the case and open a new case with the new Head of Household for the other household members. Proceed with the IDOC application for the inmate. If there is no known Head of Household for the remaining household members, leave the inmate on the case as Head of Household. Deny the IDOC application. Be sure to document the situation in the case write up. At a future time, an individual who could be the Head of Household for the remaining household members may become known. Follow up as needed at that time. Do not terminate medical coverage for other household members solely due to the absence of a Head of Household.

Living Arrangement on an Active Case

Worker Action Required

Inmate is the only active individual on the case

Change the address on the active case to the IDOC facility and deny the IDOC application. A central notice Form 360C will be generated.

Inmate is active along with other household members

Split the case in IES so the inmate is on a separate case from the other household members and deny the IDOC application.

As long as the applicant is confined to the IDOC facility, the individual's presence in the household cannot be included in the EDGs of the other household members.

Inmate is the head of household (HoH) on the active case with other household members

If another individual can be established as Head of Household, close the case and open a new case with the new Head of Household for the other household members. Proceed with the IDOC application for the inmate.

If there is no known Head of Household for the remaining household members, leave the inmate on the case as Head of Household. Deny the IDOC application. Be sure to document the situation in the case write up. At a future time, an individual who could be the Head of Household for the remaining household members may become known. Follow up as needed at that time.

Do not terminate medical coverage for other household members solely due to the absence of a Head of Household.

Follow policy described in PM 03-10-01 and PM 03-23-01 for incarcerated individuals receiving SNAP or cash assistance.

Step 2 Following Up: Release to the Community

Provide necessary follow up to the approved case when the inmate is released or notify other offices as needed. Update the case with the community address and include in the write up the date of release. Other changes may include the following:

Merge the IDOC case with an existing case;
add the released individual to an existing case and close the IDOC case;
process written/signed requests for SNAP or cash assistance per existing policy; and
transfer the updated case to the FCRC office of choice as appropriate.

When making changes to the individual's case and the family case, review eligibility for each household member. Do not create a gap in medical coverage if the individual and household members qualify for medical coverage.

Community Address & Living Arrangement

When an inmate is released from prison, the inmate is responsible for notifying the FCRC of their community address. Some inmates may choose to report a change of address through the post office. The National Change of Address Service (NCOA) automatically updates addresses reported by the U.S. Post Office once a month around schedule 09 in IES.

Note: DHS mail sent to an IDOC facility will not be forwarded to the community address after the inmate is released to the community.

Living Arrangement & Tax Filer Status

Medical eligibility based on living arrangement follows existing policy. Individuals who are subject to Modified Adjusted Gross Income (MAGI) budgeting should report if they expect to be a tax filer or expect to be claimed as a tax dependent. If tax filer status is not known, use case history if the individual is known to the system or use relationship rules. Do not take negative action if tax filer information is not known or provided.

Individual Reunites with Family Members who Have an Active Case

A released individual may move in with family members including:

A spouse;
dependent children under age 19;
parent(s); or
other relatives.

When the family members have an active medical case, review eligibility for all active household members including tax filer/tax dependent status for MAGI households and update the case(s) as needed.

Release Date is Postponed After the Application is Submitted

In some circumstances, the scheduled release date for an inmate may be postponed. If the application has already been approved for an inmate whose release date has been postponed, do not cancel the inmate's medical case. The inmate is responsible for any action required to maintain the active case including the annual REDE. If the inmate fails to cooperate in a required case review or REDE, cancel the case.

Examples

Example 1: Mr. E is an IDOC inmate and applies for medical benefits on September 30. His release date is November 29. The FCRC registers Mr. E's application for medical benefits. Mr. E is determined eligible for ACA Adult and is approved November 8. IES sends a record to MMIS upon approval showing the start date of medical coverage is September 1. When the weekly IDOC file runs against MMIS, HFS automatically enters the OBRA code in MMIS to restrict his medical benefits. On November 29, the weekly IDOC file confirms Mr. E was released and HFS removes the OBRA code CI restoring full medical benefits effective with the date of release.

Example 2: Ms. F is an IDOC inmate and applies for medical benefits on October 2. Her release date is December 3. The FCRC registers Ms. F's application for medical benefits and approves her for ACA Adult. Ms. F later reports she is released from IDOC and is now living with her 10 year old son who is active on an All Kids Assist case. Update Ms. F's address from the IDOC address to her community address. Ms. F is eligible for FamilyCare; merge her case with the All Kids Assist case.

Example 3: Mr. G is an IDOC inmate and applies for medical benefits on November 16. His release date is December 13. The FCRC registers Mr. G's application for medical benefits. On December 26, the FCRC learns that Mr. G was not released after all. The FCRC leaves the ACA Adult case active. Mr. G's medical benefits in MMIS remain restricted until he is released.

Inmates Apply for Medical After an Inpatient Hospital Stay

The All Kids Unit processes applications from inmates who receive inpatient hospital services during their incarceration and are not planning for discharge from the IDOC facility. These applications are hand delivered to the All Kids Unit by the IDOC health services vendor. In IES, enter the address of the facility in which the inmate is residing.

Active Cases-Individual Goes to Prison

When an individual active on a medical case is admitted to an IDOC facility, do not cancel the individual's medical coverage solely due to the incarceration. Depending on the household composition, some actions may be required to remove the individual from other household members' EDGs so that the correct income standard is used to determine ongoing eligibility. Refer to the Living Arrangement Table listed earlier in this release for action steps.

Immediate Access to Medical Coverage

When an inmate is released to the community and is in need of immediate medical coverage, call the HFS Member Benefits Hotline at 1-800-226-0768 or send an email to HFS.IESAccess@illinois.gov with the individual's name, case number and RIN. HFS central office staff will review IDOC records to verify the individual's release and close the OBRA segment to restore full medical coverage.

Individuals in an Illinois County Jail

Individuals confined in an Illinois county jail may apply for medical benefits as a result of receiving inpatient hospital services or as part of discharge planning. There is no longer a restriction on the number of days in advance of the anticipated release that an application can be filed.

Miscellaneous Changes

Department of Children and Family Services (DCFS) no longer refers to children who receive foster care assistance as wards. They are referred to as 'youth in care.' Changes will be made to update these references over the next several months as the policy manual is updated.
References to the Medical Field Operations (MFO) office now include the two new hubs, MFO Central and MFO downstate. Out of date references to old procedures for the processing of LTC and SLP applications are removed.
A new page is added to WAG 25 to show which office certifies and maintains cases by program in IES.