02/24/2023
Obsoletes Policy Memorandum COVID-19 Emergency Medical for Non-Citizens dated 7/2/2020.
Summary:
This manual release obsoletes Policy Memorandum COVID-19 Emergency Medical for Non-Citizens dated 7/2/2020. This manual release provides clarification of required documentation for medical coverage beyond 120 consecutive days.
Both the federal and state governments have declared the COVID-19 pandemic as an official disaster occurrence. Due to these declarations, a diagnosis or suspicion of COVID-19 qualifies as an emergency for non-citizens who do not meet federal Medicaid qualifying eligibility criteria. Due to the COVID-19 emergency declaration, non-citizens who do not meet federal Medicaid qualifying eligibility criteria and are diagnosed with COVID-19 or suspected of having COVID-19 are eligible for emergency medical coverage without Client Assessment Unit (CAU) approval.
- COVID-19 Diagnosis
- Initial Request for Emergency Medical
- Approval
- All Kids Unit Processing
- Required Information for Approvals Over 120 Days
- Verification Checklist (VCL)
- Notification of Decision
- MANUAL REVISIONS
- Forms referenced
- Notices
COVID-19 Diagnosis
Non-Citizens who have been diagnosed or are suspected of having COVID-19 are eligible for emergency medical coverage without a CAU approval.
Initial Request for Emergency Medical
An application for COVID-19 Emergency Medical must include:
- Documentation from a licensed medical professional that COVID-19 is either diagnosed or suspected,
- Documentation that provides the name of the medical professional attesting to the diagnosis or suspected diagnosis, and
- Date of diagnosis, or a signed and dated copy of form HFS 3801 Report of Medical Treatment.
Note: Applicants who are not citizens or do not have satisfactory immigration status are not eligible for presumptive eligibility.
Approval
COVID-19 Emergency Medical coverage period is authorized for 60 days from the start date of coverage. The start date is determined by the date on which the COVID diagnosis or suspected diagnosis was made.
Medical coverage for emergency COVID-19 diagnosis or suspected diagnosis begins the earlier of:
Date of COVID-19 diagnosis or suspected diagnosis on a completed HFS 3801 or other documentation; or
- Date the application is received.
COVID-19 emergency medical applications must be prioritized for processing upon receipt of HFS 3801 or other documentation supporting a COVID diagnosis or suspected diagnosis.
Do not forward applications with a diagnosis or suspected diagnosis of COVID-19 to CAU. If an emergency application for a COVID-19 individual is received from CAU, prioritize the application for processing upon receipt.
All Kids Unit Processing
COVID-19 related applications are assigned to Bureau of All Kids (BAK) staff for processing and tracking.
- Providers requesting coverage for a COVID-19 related individual, emails the application to HFS.priority19@illinois.gov.
- When an application is approved, BAK staff enters the initial 60 days of medical coverage into the Integrated Eligibility System (IES).
- If additional coverage is needed beyond the initial 60 days, the provider must email HFS.priority19@illinois.gov requesting an extension. The request for an additional 60 days is reviewed and if approved, BAK adds the second approval period to the case.
- BAK enters a case comment upon completion.
Required Information for Approvals Over 120 Days
If extended coverage is needed beyond 120 days, the provider must email HFS.priority19@illinois.gov with the request for the extended coverage at 60 day intervals. The provider must also submit medical records with each request. When requesting extended coverage for COVID-19 related individuals, the following medical documentation is required:
- Facility name providing service;
- Attending physician contact information;
- A statement signed by a licensed medical professional providing the dates of service being reviewed past the 120th day through the end of the COVID-19 illness/treatment;
- Admission history and current physical examination from the current facility;
- Typed or clearly readable summary of care delivered at the facility since admission including plan for further care (1-2 page summary);
- Copies of all progress notes and test results within the week prior to the request for extended coverage; and
- HFS 3801 Report of Medical Treatment (if provided).
The request for extended coverage and supporting medical documentation is then sent to the HFS medical reviewer for approval. Extended coverage may be available throughout the COVID-19 related illness/treatment.
Verification Checklist (VCL)
Send a VCL for applications received without the required verifications.
Notification of Decision
Providers are notified by email of the decision upon review of each request.
MANUAL REVISIONS
[signed copy on file]
Grace b. Hou
Secretary, Illinois Department of Human Services
Theresa Eagleson
Director, Illinois Department of Healthcare and Family Services
Forms referenced
Notices
Provider Notice Emergency Medical Coverage for Persons Not Meeting Immigration Status with COVID-19 Diagnosis issued 6/24/2022.
