MR #23.07 Medical Extension Updates

Illinois Department of Healthcare and Family Services Logo Illinois Department of Human Services Logo

02/09/2023

Summary:

Medical Extension (ME) may not exceed four months when increase is due to spousal support and may not exceed twelve months when the increase is due to earnings.
The Integrated Eligibility System (IES) is updated to authorize medical extension based on the month in which the customer first received an increase in income above the eligibility standard.
IES automatically calculates the medical extension period.
The Medical Extension Type of Assistance (TOA) is only displayed on the Eligibility Summary page for approved months.
This manual release provides guidance for processing the receipt of a HFS 3361 after the due date.
This manual release provides guidance for processing late reporting of an increase in earned income or spousal support.
Policy Memoranda, Update to the Illinois Medicaid Redetermination Project (IMRP) for SSI and Medical Extension Cases dated 9/24/2013, is obsolete.

Determining the First Month of Medical Extension
Increase in Earned Income
Increase in Spousal Support
Medical Extension is Only Displayed in IES for Ongoing Months
HFS 3360A Medical Extension Approval Notice
Bypassing of a Quarterly Report (HFS 3361)
First HFS 3361 Received After Due Date
Adding an Adult Back to Medical Extension
OneNet Updates
MANUAL REVISIONS
Forms referenced

The medical extension certification period begins the first month the family should have stopped receiving TANF or Family Assist due to an increase in spousal support or employment earnings. This is the month the action should have been taken had the earnings or spousal support been reported timely. This manual release provides guidance on the updates made to IES.

Determining the First Month of Medical Extension

IES automatically determines the ME eligibility period. The first day of the month in which a customer receives the increase is considered month one of the ME certification period.

Example 1: Steve and his 6 year old son, Pete, are active on a Family Assist and All Kids Assist case. Steve receives a raise from his employer on 05/09/2022. Income verification received on 07/08/2022. The household income is above the Family Assist standard. The household is eligible for ME. May 2022 is the first month Steve received the increase in income and is determined to be the first month of the ME period.

Increase in Earned Income

Customers must provide verification of an increase in earned income by cutoff of the fourth month from the month in which the increase was received or the customer will not be eligible for ME.

Example 2: Dawn and her 10 year old son, David, are active on a Family Assist and All Kids Assist case. Dawn was unemployed and is hired for a new job that started 03/05/2022. Dawn receives her first pay from the new job on 03/19/2022. Verification of the earned income must be received by 6/15/2022. Customer provides verification on 05/31/2022. The new income is above the Family Assist standard. Since the increase was due to earnings, customer is eligible for ME beginning 03/2022.

Increase in Spousal Support

Customers must provide verification of an increase in spousal support by cutoff of the third month from the month in which the increase was received or the customer will not be eligible for ME.

Example 3: Jane and her five year old daughter, Jill, are active on a Family Assist and All Kids Assist case. Jane reported that she received an increase of spousal support on 10/13/2022. Jane must provide verification of the increase by 12/15/2022. Customer provided verification on 12/05/22. The increased spousal support exceeds the Family Assist standard. Since the increase was due to spousal support, customer is eligible for a 4 month ME beginning 10/2022.

Example 4: Ruth and her six year old daughter, Lisa, are active on a Family Assist and All Kids Assist case. Ruth reported that she received an increase in spousal support on 1/10/2022. Ruth must provide verification of the increase by 3/15/2022. Customer provided verification on 3/20/2022. The increased spousal support exceeds the Family Assist standard. Ruth failed to provide verification of the increased spousal support by cutoff of the third month from the month in which the increase was received, therefore, the customer is not eligible for ME.

Medical Extension is Only Displayed in IES for Ongoing Months

The type of assistance displayed on the Eligibility Summary page will be All Kids Assist (AK Assist) and Family Assist (FamilyCare) for months prior to the approval of ME. The ongoing months will display the type of assistance as ME (Med Ext) for adults and continue to display All Kids Assist for the children.

Example 5: Sandra and her 11 year old daughter, Madison, are active on a Family Assist and All Kids Assist case. Sandra receives an increase in her employment income on 02/02/2022. The increase in income is above the Family Assist standard. Sandra provides verification of the increase on 04/17/2022 and is approved for the ME. Sandra and Madison will show as active in Family Assist and All Kids Assist through 05/2022. Beginning 06/2022, the Eligibility Summary page will display the type of assistance as "Med Ext" for adults and continue to display All Kids Assist for the children.

HFS 3360A Medical Extension Approval Notice

The HFS 3360A is sent upon certification of an approval for cases that transition to medical extension.

Bypassing of a Quarterly Report (HFS 3361)

When an increase in earned income is reported late (after the cutoff of the third month but before the cutoff of the fourth month), an individual may continue to receive ME (if otherwise eligible). Due to the late reporting, the first quarterly report will not be generated and is bypassed. When the first quarterly report is bypassed:

IES populates the "4 Month Quarterly Report Date" on the REDE Received Details page with the date that ME is certified to prevent auto cancellation.
IES adds the following case comment: "Creation of the 1st 3361 was bypassed. IES systematically populated the receipt date in the "4 Month Quarterly Report Date" field to prevent auto cancellation. The caseworker is not required to generate the 3361 manually.

Example 6: Ralph is certified into medical extension on 2/10/2021 due to earnings that increased effective 09/05/2020. Since his 12 month certification period started in September, it is too late to generate the first 3361 which should have been issued on 11/15/2020 (cutoff of the 3rd month). IES enters 2/10/2021 as the receipt date in the "4 Month Quarterly Report Date" field to prevent an auto cancellation. The next quarterly report form will be generated in mid-February, which is the 6th month of the certification period.

First HFS 3361 Received After Due Date

ME benefits are scheduled to be closed effective the seventh month when a first quarterly report (HFS 3361) is not received by cutoff in the fourth month, however, the adult customer may still remain eligible for a six month extension of ME if the first quarterly report is received prior to the end of the fifth month.

Example 7: ME certification period is January through December. The first quarterly report is due by 04/15/2020. Mr. Smith failed to return the quarterly report by the due date, therefore ME benefits are to be canceled effective July. However, the signed report is received on 05/18/2020 and recorded in IES. Due to receiving the report prior to the end of the fifth, Mr. Smith remains eligible for the sixth month extension.

Adding an Adult Back to Medical Extension

ME benefits are scheduled to be closed effective the eighth month when a second quarterly report is not received by cutoff of the seventh month, however, their benefits may be reopened if the second quarterly report is received no later than the end of the ninth month of the certification period.

Example 8: ME certification period is January through December. The second quarterly report is due by 7/15/2020. Mrs. Evans failed to return the quarterly report timely, therefore ME benefits are closed effective August. The signed report is received on 9/20/2020 and recorded in IES. Mrs. Evans meets the ME program criteria listed in PM 18-05-07-b and may be added back to the medical extension case and resume receiving benefits (See PM 18-05-07-a).