Upon implementation of the Integrated Eligibility System (IES) phase 2, the process for completing a redetermination is changed. The selection criteria for the Medical REDE process is described below. IES determines the appropriate mode for a medical REDE based on the Type of Assistance assigned for each Eligibility Determination Group (EDG), certain case characteristics and the results of a clearance check.
Step 1- Medical REDE Selection Process
Criteria for Medical Auto-REDE
The medical programs/services described in the table below are potentially eligible (non-excluded) for auto-REDE. Some financial and non-financial data have been previously verified and updated in IES through regularly scheduled interfaces or by worker action during the clearance check.
The medical programs/services described below are potentially eligible (non-excluded) for auto-REDE:
- All Kids Assist (non-spenddown)
- All Kids Share
- All Kids Premium Levels 1 & 2
- Moms & Babies (non-spenddown)
- ACA Adult
- Former Foster Care
- SSI recipients receiving AABD Medical
- SSI recipients receiving long term care (LTC)-nursing home, Supportive Living Facility (SLF), Department on Aging (DoA) or shelter care services
- Disabled Adult Children (DAC), Widow(er) and Section 1619 cases
Exclusions to the Auto-REDE Process
By Program and Service
The following programs and services are excluded from auto-REDE:
- Medical extension
- Cases in spenddown status
- AABD medical (does not receive SSI)
- Medicare Savings Program (QMB, SLIB, QI-1)
- Any medical program when the individual is receiving LTC-nursing home, SLF, DoA or (does not receive SSI income)
- Shelter care services (medical and medical spenddown)
- Health Benefits for Workers with Disabilities (HBWD)
- Veterans Care
- Health Benefits for Persons with Breast or Cervical Cancer (BCC)
Special Case Conditions
The following situations in IES disqualify a case from being selected for auto-REDE.
- Clearance information that conflicts with data on file in IES for the persons in the case;
- Cases with persons who are counted in a medical EDG in more than one case;
- Persons who are included in the EDG whose identity/relationship/income is unknown in IES including cases still showing the source of the information is from "conversion"; and
- Cases where benefits issued in the CDB do not match benefits determined in IES for one or more persons.
In IES, the Conversion Summary Information must show there are no unknown relationships, no potential merge cases and no discrepancies in benefit match with SNAP and cash assistance.
Example: Mr. Alpha is active on an adult only FamilyCare case and is RPY for his children on a separate All Kids case. Mr. Alpha is not eligible for auto-REDE.
Example: Mr. Bravo is an SSI recipient and active on an AABD case. There are 3 people in the standard. The CDB does not list any information regarding the other 2 people or their relationship to Mr. Bravo. He is not eligible for auto-REDE.
Example: Ms. Charlie is active on an ACA Adult case (EDG size = 1) and her only income is UIB of $500/month. However, she is a component household member on a separate SNAP case where she has earned income of $1,400 per month (which exceeds the standard for ACA Adult). She is not eligible for auto-REDE.
Step 2-Medical REDE Clearances
Approximately 75 days prior to the REDE due date (after cutoff of the 3rd month prior to certification end date), IES runs clearances for all cases due for a REDE.
The manual medical REDE (form 643M, 643N or 643X) is pre-populated with information found in the clearances. When the household receives SNAP or cash assistance, the medical form 2381B is pre-populated with information found in the clearances and sent with REDE form IL 444-1893.
Example: Mr. Delta was approved for medical benefits with a certification period Jan 2016 through Dec 2016. Clearances are run on 10/18/2016 (about 75 days prior to the end of the cert period 12/31/2016). A REDE notice (Process Form A or B) is mailed by 10/31/2016. The REDE due date is 12/01/2016.
IES reviews the following sources during the clearance check:
- The Work Number (TWN) and AWVS for earned income;
- The IES case record for unearned income. The IES case record is updated regularly through various interfaces;
- Secretary of State for residency;
- The IES case record for other non-financial data.
If the income found electronically for each individual is within the income standard, IES will proceed with auto-REDE for the case. For cases not excluded from auto-REDE, IES will compare the IES case information to the clearance results. The table below lists the conditions under which a case will qualify for auto-REDE. Cases that fail this step are routed to the manual REDE process (B).
|Income on IES Case Prior to REDE
|Income from Step 2 Clearances
|Qualifies for Auto-REDE / Process A
|Earned income only or both earned and unearned income
|TWN or AWVS clearance shows income and all individuals remain eligible for medical benefits (even if children are moved to higher level such as from Assist to Share)
|No income is returned by TWN or AWVS
|Unearned income only
|TWN or AWVS clearance shows no income
|TWN or AWVS clearance shows income and all individuals remain eligible for medical benefits
|No income is returned by TWN or AWVS
Electronic Data Not Available
The case cannot be selected for auto-REDE if financial or non-financial data cannot be verified electronically:
- Households with income that cannot be verified electronically include self employment income, private pensions/retirement benefits, unemployment benefits received from another state and other unearned income; or
- Persons for whom IL residence cannot be verified electronically during the clearance process.