MR #14.35: Extended Medical Policy Changes

Illinois Department of Healthcare and Family Services Illinois Department of Human Services

12/16/14

Summary:

Under Modified Adjusted Gross Income (MAGI) budgeting, Family Health Plans are no longer canceled due to excess child support income.
- Medical extensions due to excess child support are no longer authorized.
- When a TANF case becomes ineligible due to excess child support income, determine continued eligibility for medical benefits and SWAP the case to medical if eligible.
Since spousal support is counted under MAGI, a medical extension may be authorized when a TANF or Family Assist case becomes ineligible due to excess spousal support.
Effective immediately, Extended Medical benefits that were state only funded are no longer authorized.
- The Extended Medical program is no longer available for families due to increased income of a person who is not in the case.
- The Extended Medical program is no longer available for families when the case has not been active for at least 3 of the 6 months immediately before the month of ineligibility.
- Adults receive a maximum of 4 months Extended Medical when it is received as a result of excess spousal support (children have 12 months continuous eligibility).

Medical Extensions Are No Longer Authorized Due to Child Support Income
1. SWAPS from TANF to Medical Only
  1. MAGI Budgeting
  2. Civil Unions
Medical Extensions Due to Spousal Support Income
1. System Changes
Eliminating State Only Funded Medical Extensions
1. TANF to Medical Extension
2. Family Assist to Medical Extension
MANUAL REVISIONS

Medical Extensions Are No Longer Authorized Due to Child Support Income

Child support income is not counted under MAGI budgeting policy. For that reason the receipt of excess child support is no longer a reason to cancel a Family Assist case and to provide Extended Medical benefits.

When a customer becomes ineligible for TANF cash due to excess child support income, determine continued eligibility for medical benefits. Swap the case to medical only if eligible. Use type action (TA) 81 or 82, and type action reason (TAR) 24 when swapping a TANF case to medical only.

SWAPS from TANF to Medical Only

MAGI Budgeting

When a case is swapped from TANF to medical only, the recipients are no longer automatically deemed eligible for medical benefits. For Family Health Plans and the ACA Adult group, use MAGI budgeting methodology to determine the EDG sizes and budgetable income. For more information see the 9/26/13 policy memo, MAGI Budgeting for Medical. Until IES Phase 2 (when eligibility for active cases can be run in IES) staff may use the MAGI Calculator to assist with the budgeting process.

Civil Unions

As a reminder, civil union partners are recognized as spouses for TANF, but not for medical. See the 6/19/14 manual release, Same Sex Marriage & Civil Unions. If the TANF case contains an optional civil union partner, delete the optional civil union partner from the case using TA 34 TAR 16 and determine their eligibility for the ACA Adult program.

The notice message for TA 34/TAR 16 is: "x______x has been deleted from your case because he/she is not the caretaker relative, parent of an eligible child, or spouse of the caretaker relative."

Medical Extensions Due to Spousal Support Income

Spousal support income is counted under MAGI. Spousal support (or alimony) is income received by a person from their spouse or former spouse under a divorce decree or written separation agreement that is specifically for the support or maintenance of the other spouse.

When a TANF or Family Assist case becomes ineligible due to the receipt of excess spousal support, a Medical Extension may be authorized for up to 4 months for adults on the case. Because a child's continuous eligibility is reset for 12 months at the start of the medical extension, children will continue to receive medical coverage through 12 months if otherwise eligible.

Note: IES will be programmed to generate a REDE notice before adults reach the 4 month limit. Until IES Phase 2 is implemented, FCRC staff must alert the Medical Extension Unit (MEU) when a case is authorized extended medical due to the receipt of spousal support. MEU must set a control to determine whether the adult is eligible under another program, or must be canceled after the 4 month period.

System Changes

Cancellation TAR 21 is no longer valid to cancel TANF due to the receipt of excess child support. Instead TAR 21 is to be used to authorize a medical extension when the case becomes ineligible for TANF due to the receipt of spousal support income. The message on the 157 has been updated as follows:

"Due to the amount of your spousal payments, you are no longer eligible for cash benefits.
The adults in your family qualify for medical benefits through (*date). Children in your family under age 19 may qualify through (**date). PM 08-01"

*The first date in the above message will be the last day of the 4 month eligibility period that starts with the date entered in Item 77 (example: Item 77 = 04/01/14; the 1st date = 7/31/14)

**The second date in the message will be the last day of the 12 month eligibility period that starts with the date in Item 77 (example: Item 77 = 04/01/14; the 2nd date = 3/31/15)

Eliminating State Only Funded Medical Extensions

Effective immediately, to receive extended medical the family must have:

received TANF or Family Assist in 3 of the last 6 months, and
has lost eligibility for TANF or Family Assist because of new or increased earnings or spousal support, and
the person who is working, or who receives the spousal support, has to be a parent or caretaker relative in the TANF unit, or received benefits as a parent or caretaker relative under Family Assist.
Also, adults receive a maximum of 4 months Extended Medical when it is received as a result of excess spousal support.

TANF to Medical Extension

The following cancellation type action reasons had been used to authorize state funded Medical Extensions on TANF cases and are no longer valid:

TAR 08 (Case closed due to earnings from a person not included in the case or case had not been active for at least 3 of the 6 months immediately before the month of ineligibility)
TAR 83 (Client failed to verify earned income identified by the New Hire List and the case had not been active for at least 3 of the 6 months immediately before the month of ineligibility), and
TAR 84 (Client requests cancellation due to earnings from a person not included in the case or the case had not been active for at least 3 of the 6 months immediately before the month of ineligibility.)

Family Assist to Medical Extension

Determine whether the family meets the criteria for Extended Medical. If yes, use a TA 31 to change Item 25 from an F to an X and to enter the first month the case was ineligible, had the change been reported timely, in Item 77.

If the family does not meet the criteria for extended medical, determine eligibility for all medical other programs. Continuous eligibility applies to children under age 19 (see WAG 18-05-05). Cancel medical benefits for persons who have family income over the income standard (318% of the FPL for children when continuous eligibility does not apply, and 138% of the FPL for Parents/Caretaker Relatives and ACA Adults).