Form 3847 Notice to Noncitizen Pregnant Women

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  • Form 3847 Notice to Noncitizen Pregnant Women will be sent centrally at the 7th and 9th month of pregnancy to all noncitizen women whose immigration status is unknown.
  • Form 3847 informs these women that if they have a Social Security Number and proof of immigration, they may continue to receive medical benefits following the 60 day post partum period.

  1. Case Action Required

This policy memorandum was prepared by Healthcare and Family Services (HFS). HFS administers the Medicaid and All Kids programs. These programs provide medical benefits to families with children and to other persons. This information is to be used by staff of the central All Kids and Health Benefits for Worker's with Disabilities (HBWD) Units and the Illinois Department of Human Services when determining eligibility and authorizing medical benefits.

When applying for Moms & Babies, pregnant women are not required to provide their Social Security Number (SSN) or proof of immigration because this information is not needed for eligibility. However, some women may actually be able to meet immigration requirements.

Centrally generated Form 3847 Notice to Noncitizen Pregnant Women advises  women whose records do not include SSNs or alien registration numbers to provide their SSN and proof of their immigration status if they have them. By providing this information, the woman may qualify for FamilyCare when their 60 days post partum coverage ends.

Beginning 10/07, Form 3847 Notice to Noncitizen Pregnant Women will be centrally sent to women whose immigration status is unknown.  Women selected for this notice will have an Item 74 code 36 or will not have an SSN.

This form will be sent at the 7th and 9th months of pregnancy based on the Estimated Date of Delivery.  If the woman is approved for Moms & Babies after her 7th month of pregnancy, only one notice is sent. 

Case Action Required

If a caseworker receives a response from a woman who states she has these documents, ask her to send copies of them.  If she needs a postage paid envelope, send one to her. 

When the documents are received, review the woman's eligibility for FamilyCare.  If she meets citizenship or immigration requirements, enter the appropriate code in Item 74 and enter her SSN. 

If she does not meet immigration requirements, no further action is needed.

If the woman does not qualify for FamilyCare coverage due to excess income or has no eligible child in the home following her pregnancy, send her an application for Illinois Healthy Women Form 2378HW (pdf) if she meets the following requirements listed below.

  • Countable income is less than or equal to 200% of the FPL,
  • She is age 19 through age 44;
  • She meets immigration requirements and provided a Social Security Number; and
  • She does not qualify for FamilyCare Assist, Share or Premium following 60 days post partum.

For more information on the Illinois Healthy Women expansion, see policy memorandum Illinois Healthy Women Expansion dated 07/05/07

[signed copy on file]


Secretary, Illinois Department of Human Services


Director, Healthcare and Family Services

Forms referenced:

HFS Form 3847