WAG 17-02-02-a: Approval of Medical Prior to the 30th Day

PM 17-02-02-a.

When an applicant applies for cash assistance, gather all the information/verifications you need to determine eligibility. When all eligibility factors have been met and 30 days have not passed since the date of application, approve medical assistance.

Do not delay the authorization of medical assistance when all eligibility factors have been met just because it is less than 30 days following the date of application.

When you receive all the information needed to determine eligibility and it is not 30 days since the date of application, do the following:

  • If the case is ineligible for cash but eligible for medical assistance, deny the cash request and approve the case for medical. This action can be taken any time prior to the 30th day following application.
  • If the case is eligible for AABD, approve medical assistance on the case through the use of the following:

TA 10/TAR 37 Medical Assistance Approved while Cash Application is Pending.

Under the TA 10/TAR 37 action, the case is approved for medical only and the cash application is automatically reregistered. Make the disposition for cash assistance after the 30th day.

TA 10/TAR 37 allows the worker to:

  • approve medical assistance through AIS or IPACS under the cash assistance category (i.e., 01, 02, 03), and
  • authorize medical assistance from the beginning date of eligibility (i.e., as far back as 3 months, if appropriate).

With the TA 10/TAR 37 action:

  • Only a 4-digit approval date is allowed.
  • Medical assistance is authorized through the 60th day from the application date. For example, if the application date is 03/10 and a TA 10/TAR 37 action is processed, medical assistance will run from 03/10 through 05/09 (i.e., 60 calendar days).

    NOTE: Although medical assistance is only authorized through the 60th day following application, the case has been approved for medical assistance. Medical assistance must be continued from that point, if eligible, through disposition of the reregistered application. 

  • Food stamps cannot be authorized. Authorize food stamp benefits via mercury.
  • The system generates a MediPlan card.
  • The system centrally generates Form 360C to notify the client of their eligibility for medical assistance. On the notice, the following statement is included:

    Your request for cash assistance is still pending. 

  • The system reregisters the cash case using the original application date.

A temporary medical card may be issued to the client after the TA 10/TAR 37 action is processed, if one is needed.

Disposal of the Reregistered Cash Application

The process for disposing of the reregistered application depends on what benefits, if any, the family is determined eligible to receive.

Eligible For Cash

  • Once the case is reregistered and eligibility for cash is established, wait until the 30th day following application to approve the case.
  • Backdate medical up to 3 months prior to the date of application.
  • Use the assistance unit members' RINs that were created under the TA 10/TAR 37 action.

Ineligible for Cash and Medical Assistance

The client is ineligible for medical if they became ineligible for cash after medical had been authorized under the TA 10/TAR 37 action, because they:

  • are no longer a resident of Illinois (TA 05/TAR 07) or
  • became institutionalized (TA 05/TAR 26).

If the cash application is denied for either of these 2 reasons:

  • suppress the central notices, and
  • manually send a denial notice for cash, and
  • manually send Notice of Change (Form 157) for medical.

NOTE: Make sure to correctly include the first day for which medical eligibility will stop on the form. For example, if medical runs through 05/09, indicate that 05/10 will be the first day for which medical will stop.

Do not send a denial notice for medical assistance.

Ineligible for Cash but Eligible for Medical

After medical has been authorized under the TA 10/TAR 37 action, if the client is determined ineligible for cash:

  • deny the cash application, and
  • progress the case to Medical, and
  • use the RIN that was created under the TA 10/TAR 37 action.

The denial of cash and approval of medical can be authorized at any time prior to the 30th day.

Suppress the central notices and send a denial notice for cash. No notice is needed concerning medical assistance unless the case status changes to Spenddown.