03/29/2022
Policy Memo
Health Benefit Coverage for Immigrants only applies to immigrants between age 55 and 64 who are not eligible for Medicaid assistance in Illinois due to immigration status.
Summary:
Healthcare and Family Services (HFS) introduces the Health Benefit Coverage for Immigrants Age 55 through 64 Years Old. The Medical Eligibility Determination Group (EDG) is determined by using Modified Adjusted Gross Income (MAGI) budgeting. This program is state funded, only.
Individuals may be approved for this benefit in IES beginning 03/25/2022. The new benefits official start date is 05/01/2022 and the backdated months are available. Backdated months are considered February, March and April 2022. Coverage cannot be given prior 02/01/2022 regardless of the application date.
Example: If an application is received 03/28/2022 and requests backdating, the only eligible month for backdating in this situation is February 2022.
REMINDER: The earliest date of coverage for Health Benefits for non-citizens in this eligibility group is 02/01/2022 which includes backdating. The program does not exist in IES prior to March 2022.
NOTE: Individuals age 55 through 64 and over 65 with emergency medical needs must be evaluated for Emergency Medical for Noncitizens. Emergency Medical for Noncitizens should be evaluated and determined as described in the linked Manual Release. Coverage under the Health Benefits for Immigrants Age 55 through 64, and coverage under the Health Benefits for Immigrant Seniors (age 65 and over) can overlap Emergency Medical.
Eligibility Criteria:
This program follows MAGI eligibility budgeting. An individual may be eligible for this program provided all the following criteria are met:
- customer is not a U.S. Citizen;
- customer has a non-citizen status that does not meet the criteria for Medicaid (see PM 03-01-00);
- customer is a resident of the State of Illinois;
- customer's income is at or below 138% FPL; and
- customer is age 55 through 64 years old. If the age cannot be verified electronically, we accept self-attestation.
Eligibility
- An individual is not eligible for this program if they are eligible to be enrolled in a federally funded Medicaid program.
- An inmate of a public institution may be considered eligible with limited benefits.
Case Maintenance
These cases are processed and maintained the same as ACA and Family Health Plan Cases.
- Medical EDGs will be redetermined annually.
- Customers turning 65 years old will automatically be considered for the Immigrant Seniors Program.
- Medical EDGS may be cancelled when:
- customer does not respond timely to requests for information;
- customer requests cancellation;
- customer moves out of state; or
- customer's status no longer meets eligibility criteria listed below:
- income Limit; or
- becomes eligible for Medicaid programs.
Integrated Eligibility System (IES)
IES is updated to reflect the processing changes necessary to include this new eligibility group.
An indicator (A) is added to the existing ACA Adult and Family Health Plan Types of Assistance (TOA) to identify this new population. The new indicator is displayed on the eligibility summary to identify the individual found eligible for Health Benefits for non-citizens age 55 through 64 years old.
An additional statement will also be displayed in the EDG information, example below:
New MangP Code 'NI' will be set in IES and sent to MMIS, example below:
NOTE: Customers in this program are not eligible for Managed Care.
Covered services
The program will cover the same services as Family Care and ACA, except the services below:
- long term care;
- funeral and burial expenses (also not covered under ACA); and
- home and community based waiver services.
[signed copy on file]
Grace B. Hou
Secretary, Illinois Department of Human Services
Theresa Eagleson
Director, Healthcare and Family Services
