12/30/2024
Summary:
- This manual release contains guidance for the assignment of the pregnant teen (PT) indicator for the All Kids Assist (AK) and Aged, Blind, and Disabled (AABD) medical programs.
- Eligible expectant mothers under age 19 are reviewed for the AK Assist Types of Assistance (TOA).
- Eligible expectant mothers under age 19 receiving SSI or disabled are reviewed for the AABD TOA.
- Provides policy clarification for medical program requirements.
- Provides guidance for medical certification and redetermination periods.
- Expectant mothers aging out of AK Assist (PT) are transitioned to the Moms and Babies program.
- Correspondence has been updated.
- Policy Guidance
- All Kids Assist for Pregnant Teen
- Aid to the Aged, Blind and Disabled (AABD) for Pregnant Teen
- IES Updates
- Certification Period
- Redetermination
- Correspondence
- MANUAL REVISIONS
Effective 06/01/2021, expectant mothers under age 19, are not transitioned to the Pregnant Women TOA. Expectant mothers under age 19 are reviewed for AK Assist or AABD at application or remain in their current TOA and assigned the indicator (PT) if they are actively receiving medical coverage.
Policy Guidance
All Kids Assist for Pregnant Teen
To receive AK Assist (PT), a person must:
- be less than 19 years old;
- be pregnant or within the first 3 months of the postpartum period; (an expected date of delivery is not required); and
- have household income equal to or less than 318% FPL.
Expectant mothers approved for AK Assist (PT) must meet the Moms and Babies program requirements contained in PM 06-09-01.
A baby born to a pregnant teen receiving AK Assist (PT) coverage is considered a Deemed Newborn. See PM 06-09-02.
Eligible mothers may continue to receive coverage for postpartum care. Postpartum care provides up to 12 months of coverage starting with the first day of the month following the month after the pregnancy ends.
See PM 06-09-05-a.
Expectant mothers aged 18 and under with income above the AK Assist standard for the application month may be approved for Family Health Spenddown. See PM 06-09-05.
Aid to the Aged, Blind and Disabled (AABD) for Pregnant Teen
To receive AABD (PT), a person must:
- be less than 19 years old; and
- be pregnant or within the first 3 months of the postpartum period; (an expected date of delivery is not required);
- be receiving SSI or be disabled with income equal to or less than 100% FPL; and
- have assets under the limit for AABD medical. See WAG 25-03-02 (2).
A baby born to a pregnant teen receiving AABD (PT) coverage is considered a Deemed Newborn. See PM 06-09-02.
Expectant mothers approved for AABD (PT) must also meet the following requirements:
NOTE: Client cooperation requirements for child support enforcement and medical support do not apply.
The following requirements do not apply to expectant mothers approved for AABD (PT):
- furnishing or applying for a Social Security number; and
- cooperation with child support or medical support.
Eligible mothers may continue to receive coverage for postpartum care. Postpartum care provides up to 12 months of coverage starting with the first day of the month following the month after the pregnancy ends.
See PM 06-09-05-a.
IES Updates
IES transitions to Moms and Babies when a pregnant teen ages out of AK Assist (PT) and is still pregnant or in their postpartum period. Continuous Eligibility remains in effect for pregnant women transitioned to the Moms and Babies program.
The (PT) indicator is displayed on the following IES screens:
- Case-Search/Summary; and
- Eligibility Summary.
The (PT) indicator in IES is not passed to MMIS.
IES does not pend an EDG for an SSN for a pregnant teen assigned the (PT) indicator.
Note: This policy was placed into production effective October 2021.
Certification Period
Customers receiving AK Assist or AABD coverage that become pregnant, will receive a new 12 month certification period starting with the first day of the month following the month the pregnancy was reported.
Example: Jess, 17 years old, receiving AK Assist coverage, current certification period is 12/1/2020 - 11/30/2021. Jess reports that she is pregnant on 6/25/2021 with an EDD of 1/24/2022. Jess receives a new certification period of 7/1/2021 - 6/30/2022.
Redetermination
Expectant mothers receiving AK Assist (PT) or AABD (PT) coverage are redetermined at the end of the postpartum period. Expectant mothers aging out of AK Assist (PT) transition to the Moms and Babies program with no gap in coverage and are redetermined following their postpartum period.
Example: Jaz, 18 years old, receiving AK Assist (PT) coverage, current certification period is 9/1/2020 - 8/31/2021. Jaz is currently pregnant with an EDD of 7/10/2021. Jaz turns 19 years old on 8/14/2021. Redetermination performed on 8/6/2021. Jaz transitions to Moms and Babies on 9/1/2021 and receives a new cert period of 9/1/2021 - 8/31/2022.
Correspondence
The following text fragment is displayed on the 360C for an expectant mother assigned the (PT) indicator: 'Health coverage for Pregnancy provides prenatal care and delivery services. Medical coverage is available for the mother through the postpartum period and for their newborns up to age one. There are no copays for medical services during pregnancy and postpartum.'
Children category fragments will not display for the pregnant teen.
MANUAL REVISIONS
[signed copy on file]
Dulce M. Quintero
Secretary-Designate, Illinois Department of Human Services
Elizabeth Whitehorn
Director, Illinois Department of Healthcare and Family Services
