27-33-01-q: Assist, All Kids, FamilyCare Denials (TA 05 and TA 62)

Use the TARs in this sub-topic for FHPs to:

deny an application (TA 05) or person in an application; or
progress a denied application or person to another category (TA 62).

Deny a Case or Person or Case Progression (FHP)

For denials (TA 05) and case progression (TA 62) processed through IES or IPACS, the following TARs generate a central denial notice (Form 360C) with the related reason, unless Item 39 is coded to suppress the notice. If the central notice is suppressed, the Family Community Resource Center must complete and send the Notice of Decision on Application for Medical Assistance - MANG - Non-spenddown (Form 458).

NOTE: If a TAR applies only to case denial, the Reason for Denial box shows TA 05 Only. If a TAR applies only to case progression, the Reason for Denial box shows TA 62 Only.

Some of the TARs are used to notify the unit of the reason why a person was excluded for benefits. If a TAR applies to person-level only, the TAR Box shows (Person Only). If the TAR applies to both person-level and case-level, the TAR Box shows (Person & Case).

NOTE: Send the Notice of Decision on Applications for Payment of Medicare Premiums, Deductibles and Coinsurance (Form 458M), to approve or deny QMB/SLIB/QI-1 benefits when a unit member claims to be a Medicare Part A beneficiary and Form 458 is sent.

Deny an All Kids Share or Premium Case

For the denial (TA 05) of an All Kids Share or Premium application processed through IES or IPACS, the following TARs generate a central Notice of Decision on Application for Health Benefits -- All Kids (Form 360KC) with the related reason, unless Item 39 is coded to suppress the notice. If the central notice is suppressed, the Family Community Resource Center must complete and send a local Form 360KC.

Denial and Case Progression- FHP (Category 94 and 96)
TAR	REASON FOR DENIAL	MESSAGE
01	Funeral or burial application not received on time. (All except S/P, ACA Adult) TA 05 Only	We did not receive the application for funeral/burial payments by the last day of the 3rd month after the month of death. PM 15-07
02	Applicant could not be located TA 05 Only	The Department has been unable to locate you. Your eligibility for assistance cannot be established. PM 02-06
05	Applicant does not meet citizen/INS requirements. (All except S/P) TA 05 Only	You do not meet Department citizenship/ alienage requirements. PM 03-01
05 (Person & Case)	Applicant does not meet citizen/INS requirements. (Not valid for children under age 19) TA 05 Only	You do not meet Department citizenship/ alienage requirements. PM 03-01
06 (Person Only)	Refused to cooperate with CSE without good cause. (All except S/P)	You failed or refused to cooperate, without good cause, with the Child Support Enforcement Program. PM 24-01
07	Applicant not an Illinois resident, or Illinois residency not verified. TA 05 Only	You do not meet the Department residence requirement. PM 03-02
14 (Person only )	SSN requirement not met. TA 05 Only	Due to your failure/refusal to provide a Social Security number for a persons(s) for whom you requested assistance. PM 03-11
17	All Kids and Family Care Assist out of funds. (S/P Only) TA 05 Only	Enrollment is now closed. PM 06-08
19	No eligible child in the home. (All except S/P )	There is no eligible child in your home. PM 03-05
22	Parent not incapacitated. TA 62 Only (All except S/P)	Change Category from 96 to 94. No notice is sent.
23	Applicant failed to give financial information needed to decide eligibility. (All except S/P) TA 05 Only	Your eligibility cannot be determined due to your failure to provide necessary information. PM 02-07
26	Applicant institutionalized. TA 05 Only	Your needs are currently being met by the institution. PM 03-02
30	Applicant refused or unable to verify pregnancy. (Moms and Babies Only) TA 05 Only	You did not provide the Department with medical verification of your pregnancy. PM 06-09
33	Applicant is not child(ren)'s caretaker relative. (All except S/P) TA 05 Only	You are not the child(ren)'s caretaker relative. The child(ren)'s caretaker relative can request an application by calling 1-800-226-0768 (TTY: 1-877-204-1012). PM 02-02
35	Application withdrawn due to objection to CSE assignment policy. (All except S/P) TA 05 Only	Only Your application has been withdrawn at your request due to your objection to the Agency assignment of support rights. PM 24-01
36	Family did not pay their premium. (S/P Only) TA 05 Only	You did not pay your All Kids premium. PM 06-08
40 (Person & Case)	Did not give nonfinancial information. Use SSN reason (TAR 14) if SSN requirement not met. (All except S/P) TA 05 Only	Your eligibility cannot be determined due to your failure to provide necessary information. PM 02-07

42	Excess Income. (Assist & FamilyCare - Not valid for children under age 19)	FCRC: Your countable income exceeds the appropriate limit after applying your medical expenses. PM 15-08 Central All Kids Unit: Your income is above the limit. If you have large medical expenses and still need medical, contact your local DHS office. For the number of this office, call 1-866-468-7543. PM 15-08
43	Definition of emergency medical condition not met. (All except S/P) TA 05 Only	You do not meet Department definition of emergency medical condition. PM 06-05
55	Applicant did not comply with policy on potential income sources. (All except S/P) TA 05 Only	You did not comply with Department policy regarding potential sources of income. PM 09-03 PM 01-02
60	Application withdrawn. TA 05 Only	You withdrew your application. PM 17-04
65	Eligible to be included in another active 94 or 96 case. (All except S/P) TA 05 Only	No notice sent.
66	Received All Kids Rebate overpayment, therefore ineligible for All Kids Share or Premium. (Share/Premium Only) TA 05 Only	You have received a Rebate overpayment. PM 06-08
70 (Person Only)	Person withdrew request for assistance.	Per your request, you have not been included in the unit. PM 17-04
72 (Person Only)	Person no longer lives with the unit.	You are no longer living with the assistance unit/household. PM 03-05
73	Not pregnant or under age 19. (All except S/P) TA 05 Only	Person(s) is not pregnant or a child age 18 or younger. Please go to the local DHS office and apply if you want assistance for this person(s). PM 06-10

79	Refused to cooperate with medical support policy. (FamilyCare Assist ) TA 62 Only	You did not cooperate regarding medical support rights. PM 03-19
88 (Person Only)	2nd adult ineligible. (All except S/P)	You are not the caretaker relative, parent of an eligible child, or spouse of the caretaker relative. PM 04-01
90	Change or correct ID number or category. TA 62 Only	No notice is sent.
91	Countable income exceeds limits for all Family Health Plans programs. TA 05 Only	FCRC: After considering your medical expenses, your income is above the limit for medical benefits. You or your family members are not eligible for All Kids or FamilyCare. PM 06-08 and PM 15-08 Central All Kids Unit: Your income is above the limit for medical benefits. If your family has large medical expenses and still needs medical benefits, you should reapply as soon as possible through your local DHS office. If you need the address and phone number of your local DHS office, call 1-866-468-7543 (TTY 1-877-204-1012). PM 06-08
92	MPE applicant approved under a different category. (MPE Only) TA 05 Only	No notice sent.
93	Failed to complete application process for ongoing benefits within 90 days. (MPE Only) TA 05 Only	No notice sent.
D2 (PE only)	Declared family income is above the income standard	Form 3818 sent.
D3 (PE only)	Received PE within last 12 months	Form 3818 sent.
D4 (PE only)	Insufficient information provided	Form 3818 sent.
D5 (PE only)	Immigration status not met	Form 3818 sent.
E3	Applicant failed to provide signature page.	We cannot decide if you can get the benefits you applied for. We did not receive the page with your signature or other information we asked for. PM 02-04, 02-07
E4	Countable monthly income is more than 209% of the FPL and the child has health insurance.	Your children have health insurance now or have not been uninsured long enough to get All Kids. PM 06-08
E5	Countable monthly income is more than 157% of the FPL and the family withdraws the application because they object to the amount of the All Kids monthly premiums and co-pays.	You withdrew your application. PM 17-04
E6	Applicant already receiving requested assistance.	You are already receiving the benefits you requested. PM 02-04-09
G6	Person is categorically eligible for AABD or Family Health Plans. (ACA Adult only)	No central notice is sent.
K4	Persons income exceeds 138% of the FPL (ACA Adult only)	You do not qualify for medical benefits because your income is over the limit (No SNAP notice is sent)