For medical benefits, carry out the decision immediately, but no later than 90 days after the date the appeal was filed unless the appellant asked for a delay.
DHS arranges for HFS to reimburse clients for paid medical bills when directed by an appeal decision. A client may be reimbursed for paid medical bills when it is determined through the appeal process that:
In order to get reimbursed:
HFS limits reimbursement to clients for paid bills that are eligible for Medicaid payment. Reimbursement will not be made to clients for paid medical expenses when the client is still in spenddown status.
Example 1: Client has a $100 spenddown amount and pays $75 for medical care. Appeal decision determines the client should not have a spenddown. Case is no longer in spenddown status. Client is entitled to reimbursement
for the $75 payment.
Example 2: Family Community Resource Center determines client has a $100 spenddown. Client pays $75 for medical care. An appeal decision determines the spenddown amount should have been $50. The case is still in spenddown status. Client is
not entitled to reimbursement. Client can apply the $75 toward the $50 spenddown for the current or future months.
Illinois Department of Human ServicesJB Pritzker, Governor · Grace B. Hou, Secretary
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