02/26/16
Summary:
- Updates the various medical program income standards which are based on the Federal Poverty Level Income Guidelines effective 01/01/16.
- Provides details on the central conversion of Family Health Spenddown cases to Assist coverage.
- Provides details on the central conversion of All Kids Premium Level 1-2 cases to Share and Premium Level 1 cases.
- Requires the review of All Kids Share cases potentially eligible for Assist due to the change in income standards.
- Updates the Program Standards Desk Aid.
- Increase in the Monthly Medical Income Standards
- Family Health Plans & ACA Adult Income Standards
- Monthly Income Standards for AABD, Medicare Cost Sharing
- Family Assist and Family Health Spenddown Standards
- Central Conversion of FHP Spenddown to Coverage
- Central Conversion of All Kids Premium Cases
- Review of Cases Potentially Eligible for Assist
- Program Standards Desk Aid
- MANUAL REVISIONS
- Forms referenced
Increase in the Monthly Medical Income Standards
This release places in the manual the updated income standards for the programs listed below based on the 2016 Federal Poverty Level (FPL). The new standards are effective 01/01/16 for all programs except MPE. The new standards are effective for MPE on 02/17/16.
The new standards will be updated in ACM, IPACS and IES on the first processing day for April 2016 (02/17/16). For pending applications and active cases, the new standards will be applied for any budget month beginning with January 2016.
Family Health Plans & ACA Adult Income Standards
Monthly Income Standards for AABD, Medicare Cost Sharing
| Program |
Links to Amounts |
- AABD (community)
- Medicare Cost Sharing (QMB, SLIB, QI-1)
- HBWD
|
WAG 25-03-02 (2) |
Family Assist and Family Health Spenddown Standards
There is no change in the Family Assist and Family Health Spenddown standards. Children and pregnant women who qualify for spenddown must spend down to the Family Health Spenddown standard. The Family Health Spenddown program ended for non-pregnant adults effective January 1, 2014.
Central Conversion of FHP Spenddown to Coverage
Family Health Spenddown cases that no longer have a spenddown due to the increase in the monthly income standards for 2016 will be centrally converted to Assist coverage effective 04/2016. Only cases that have been opened or REDEd within the last 12 months will be centrally converted.
For pregnant women with an Expected Delivery Date (EDD) of 02/2016 or later, who is age 19 or older and has income equal to or less than the new Moms & Babies standard, Code A is entered in Item 78. If there is an entry in Item 79 with an alpha code A through E, Code 1 is entered in Item 68. When the entire case is converted, item 80 code 390 SPD will be centrally deleted. If present, Code 396 END SPD is also deleted.
For each person under age 19 with income equal to or less than the new Assist standard, Code R is entered in Item 78.
CN 16.03/CN 16.03S (pdf) is being sent to all cases where at least one person is centrally converted the week of 03/14/16. A one time Mobius report will be generated listing the cases that were centrally converted from spenddown to Assist. The report will be sorted by FCRC and caseload. Look for reports #84505183 Person in Spenddown Converted to FamilyCare Assist or #84505184 for the statewide summary.
Central Conversion of All Kids Premium Cases
All Kids Premium Level 1 cases that qualify for Share due to the increase in the monthly income standards for 2016 will be centrally converted to Share coverage effective 04/2016. Item 80 code 192 PREM will be centrally deleted, Item 73 will be updated from Z to Y or L to J and the program name display in ACID will be centrally updated.
All Kids Premium Level 2 cases that qualify for Premium Level 1 due to the increase in the monthly income standards for 2016 will be centrally converted to Premium Level 1 effective 04/2016. Item 80 Code 192 PREM and the program name display in ACID will be centrally updated.
CN 16.04/CN 16.04S (pdf) is being sent to all cases where at least one person is centrally converted the week of 03/14/16. A one time Mobius report will be generated listing the cases that were centrally converted from Premium Level 1 or 2 to Premium Level 1 or Share. The report will be sorted by FCRC and caseload. Look for reports #84505273 Central Conversion of All Kids Premium Cases or #84505274 for the statewide summary.
Review of Cases Potentially Eligible for Assist
During the week of 03/14/16, a one time Mobius report will be generated listing the All Kids Share cases that may qualify for Assist due to the increase in the monthly income standards. Offices that have cases appearing on this list are to review the Share case for Assist eligibility. If eligible, cancel the Share case then open an Assist case.
Note: Although Share cases are maintained in the All Kids Unit (LO 180), this report may contain DHS FCRC cases which have not yet been transferred to LO 180. Look for report #84505281, Potentially Assist Eligible All Kids Share Cases.
Program Standards Desk Aid
The Program Standards Desk Aid in WAG 25-03-02 (pdf) has been updated with the new income standards.
MANUAL REVISIONS
[signed copy on file]
James T. Dimas
Secretary-designate, Illinois Department of Human Services
Felicia F. Norwood
Director, Illinois Department of Healthcare and Family Services
Forms referenced
