PM 18-05-00: Change in Medical Benefits

WAG 18-05-00

A change in a client's circumstances may lead to a change in medical benefits. Such changes include:

  • changes between Spenddown and Non spenddown;
  • change to QMB Only or SLIB Only;
  • change from community spenddown to long term care credit case;
  • change between long-term care case and Community case;
  • change between Family Assist and other Family Health Plans;
  • change from Family Assist to Medical Extension;
  • Revise textchange from State Funded medical to Federally Funded medical (i.e.: change in immigration status).

Never terminate medical benefits until eligibility under all medical programs has been determined. Eligibility must be determined without requiring a new application. The only time eligibility under all medical programs does not have to be determined is when:

  • a family requests cancellation of their medical benefits;
  • the family no longer resides in Illinois; or
  • the only eligible person enters a public institution for mental disease or dies.

In these situations, cancel the case and take no further action.