Illinois SMART Act Client Notices

07/02/12

Summary:

• The Save Medicaid Access & Resources Together (SMART) Act requires service changes and reductions to HFS medical programs.
• Notices are being sent to clients in June and July 2012 to inform them of changes resulting from the passage of the SMART Act.

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The FY 2013 state budget required significant spending reductions to fill a budget hole in the Medicaid Program. The SMART Act (Public Act 97-0689) was developed by the bipartisan Legislative Medicaid Advisory Committee to reduce program costs while continuing to serve the neediest Illinois residents. 

Notices are being sent to clients this month to inform them of changes resulting from the passage of the SMART Act that will affect them.

• CN 12.15/S, Changes to Your Medical Benefits, (pdf) is being inserted with July medical cards for All Kids/FamilyCare Assist and AABD cases (white cards).
• CN 12.16/S, Changes to All Kids Benefits (pdf), is being inserted with July medical cards for All Kids Share and Premium cases (yellow cards).
• CN 12.17/S, Changes to Your Medical Benefits (pdf), is being sent to Illinois Healthy Women cases (pink cards).

Overview of Medical Program Changes

• Some optional services are eliminated, such as group psychotherapy and adult chiropractic services.
• Utilization controls are placed on certain optional services, such as adult dental services (restricted to emergency extractions only), adult podiatry services (restricted to diabetics), and adult eyeglasses (limited to 1 every 2 years).
  Note: Persons age 19 and 20 years old will continue to receive early periodic screening, diagnosis and treatment (EPSDT) services that are available to children under age 21 through the Healthy Kids Program, including dental services. See PM 20-21-00.
• Limits are placed on adult and children's prescriptions to four per month, with additional prescriptions available with special approval based on patients' needs.
• Co-pays are increased to the federal maximum for pharmaceuticals, emergency room non-emergent care and for visits to Federally Qualified Health Centers (FQHC).
• Illinois Cares Rx, a program that helped low-income seniors and people with disabilities pay for prescriptions, ends. The Notice of Termination of Illinois Cares Rx Benefit (pdf) is being sent to persons enrolled in this program. The notice provides information about Medicare Part D and the federal Low Income Subsidy (LIS) assistance program for low-income seniors and people with disabilities who are eligible for Medicare. 
• Eligibility for adults in the FamilyCare program is reduced to 133% Federal Poverty Level. See Policy Memo dated 6/06/12, FamilyCare Share, Premium and Rebate Ends for Adults for more information and a link to the client notices.
• The Chicago General Assistance Program ends. See Policy Memo dated 6/19/12, Elimination of the Chicago General Assistance Program for more information and a link to the related client notices.

Medical Expenses for Qualifying SNAP Units

Due to the change in medical programs, a qualifying member SNAP unit may incur noncovered medical expenses that are an allowable expense deduction for SNAP. Allow the appropriate Standard Medical Deduction if the unit's monthly medical expenses exceed $35. The unit's actual medical expenses may be allowed if their total monthly expenses exceed the Standard Medical Deduction. See PM 13-01-05 and PM 13-01-05-a.

[signed copy on file]

Michelle R. B. Saddler
Secretary, Illinois Department of Human Services

Julie Hamos
Director, Healthcare and Family Services

Forms referenced:

• CN 12.15
• CN 12.16
• CN 12.17
• ICRX notice