Due to the COVID-19 Emergency Declaration, effective immediately adults are eligible for Presumptive Eligibility (PE). This will ensure eligible adults receive medical care during the case determination process.
Adult Presumptive Eligibility
Presumptive Eligibility will be determined during Application Registration. When auto registration is possible, the determination will be made systematically. If the application is not able to be auto registered, the determination will be made when the application is registered.
The Child PE page has been renamed "Presumptive Eligibility". This page will be used to determine PE eligibility for children and adults. Adult PE cannot begin before March 01, 2020. Adult PE will begin the first day of the month of application or March 01, 2020 if the application date is prior to March 01, 2020.
EXAMPLE: Application date is 01/15/2020. Application is registered on 04/20/2020 and PE is approved for the adults requesting medical. The start date of the adult PE is 03/01/2020.
EXAMPLE: Application date is 04/06/2020. Application is registered on 04/20/2020 and PE is approved for the adults requesting medical. The start date of the adult PE is 04/01/2020.
Just like child PE, use the information on the application to determine eligibility for adult PE. An application with 'No' stated as the response to all income sources should be treated as declared $0 income . If an income source is declared on the application but the amount is not declared, declared income is not available and no one is eligible to receive PE.
During the PE period, the individual(s) receives the same medical benefits as individuals receiving ACA and FHP. No HFS Medical Card is issued. A KC 3818 is sent if PE is approved. A KC 3818A is sent when PE is denied.
MAGI Adults Will Appear in the Adult Section of the PE Screen for Determination. To be Found Eligible the MAGI Adult Must:
- Be age 19 - 64;
- have declared income on the application which is equal to or less than 138% of the FPL for the family size;
- be a resident of IL;
- declare to be a U.S. citizen or have a satisfactory immigration status;
- not be receiving Medicare; and
- not be approved for ongoing medical or does not have PE already.
Changes to Child PE
Children may now be approved for PE more than one time per 12 months. The check box on the PE page used to identify that a child received PE in the past 12 months has been disabled.
Auto registration will complete the PE screen and a determination will be made for children and adults based on the information provided within the application.
When PE is approved, a Form 3818 will be sent listing the names, DOB, RIN and begin date for each individual approved. The notice will include children and adults.
When PE is approved, a record will be sent to MMIS in the nightly file. The coverage will appear in both the Presumptive Eligibility and Regular Eligibility segment.
When adult PE is denied, a Form 3818A will be generated by IES. The correspondence will be visible using the T# assigned to the application. New denial reasons were added for adult PE. The denial reasons are:
||MAGI Adults Text
||The applicant did not provide enough information to make a decision.
||Individual is not an Illinois resident.
||Reported the individual is not a U.S. citizen or does not have satisfactory immigration status.
||Reported family income is more than the limit.
||Individual is receiving Medicare.
Note: Final eligibility determination for Adult Presumptive Eligibility will occur on click of the Submit button on the Register Application Summary screen.
NOTE: Currently there is NOT Presumptive Eligibility for AABD adults. A federal waiver request has been submitted to allow PE for AABD adults. If the AABD PE waiver is approved, an update to the Policy Memo will be issued.
[signed copy on file]
Grace B. Hou
Secretary, Illinois Department of Human Services
Director, Healthcare and Family Services