WAG 06-05-01-a
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.
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 HFS 3801.
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.
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 (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.
