OVERVIEW OF PROGRAMS

The Illinois Medicaid and S-CHIP programs are administered by the Illinois Department of Public Aid (IDPA) Division of Medical Programs.  Through an interagency agreement with IDPA, the Department of Human Services (DHS) determines eligibility for Medical Assistance and KidCare (including long term care services).  DHS’s local offices are organized and supervised by regions.  When providers need to make contact with DHS regarding a participant, the DHS local office that services the county in which the participant lives is to be contacted.  In Cook County, providers should contact the appropriate neighborhood DHS local office.  IDPA’s KidCare Unit can determine eligibility for children, pregnant women and parents who apply by means of a mail-in application. 

The Department of Children and Family Services (DCFS) is responsible for children who are covered by Medicaid and who are wards of the State or whose care is subsidized by DCFS.

The S-CHIP program is called KidCare.  It is a combination Medicaid expansion and separate program.  There is a joint application for all KidCare programs (Medicaid and S-CHIP), and the delivery systems are the same across programs as well.

 Illinois has a section 1115 Medicaid demonstration waiver that extends Medicaid eligibility for family planning services for 5 years to Medicaid-participating, child-bearing age women (ages 19 through 44) who would otherwise lose Medicaid eligibility for any reason other than having moved out of Illinois, not meeting a Medicaid information-provision requirement, failing to cooperate with medical support rights, or becoming an inmate or resident of a public institution.

MEDICAID

Categories for Adults

KidCare Moms and Babies – Pregnant Women

Income cannot exceed 200% of FPL.
No asset limit.

Covers outpatient services and inpatient hospital care, including delivery.  Women are covered for 60 days following delivery.

The Medicaid Presumptive Eligibility (MPE) Program provides payment for outpatient medical care services received by a pregnant woman who is determined as Medicaid Presumptive Eligible (MPE) by a qualified provider.
MPE eligibility begins on the MPE determination date and ends the later of:
·         The last date of the month following the month of MPE determination, if the woman fails to apply for ongoing assistance benefits; or
·         The application disposition date for ongoing assistance benefits.

There is no citizenship requirement for this category.

Parent Assist  -- For parents and/or caretaker relatives (and their spouse) of children or the spouse of a pregnant woman.

Income cannot exceed 90% of FPL (currently $1,380 for a family of four)
No asset limit.

The cap for parents is being raised over the next three years to 185% of FPL.

There are copayments for medical visits and prescription drugs (not to exceed $3).

Family Assist  -- For parents/caretaker relatives living with children age 18 or younger.

Must meet income requirements for TANF (see below).

There are copayments for medical visits and prescription drugs (not to exceed $3).

Breast and Cervical Cancer

The Department of Public Health performs an income test to 200% of FPL and then refers the application to IDPA for processing.
No asset limit.

Program assists individuals who have been screened under the National Breast and Cervical Cancer Early Detection Program administered by the Illinois Department of Public Health and found to have breast or cervical cancer or a precancerous condition.

Non-U.S. Citizens

Must meet the eligibility requirements of any category.

Non-citizens who do not meet immigration requirements (undocumented) are only eligible for coverage for emergency services.

Citizenship requirement does not have to be met for KidCare Moms & Babies.

Categories for Families/Children

KidCare Moms and Babies – Children under age 1

Income cannot exceed 200% of FPL.
No asset limit.

KidCare Assist – Children age 0 through 18

Income cannot exceed 133% of FPL.
No asset limit.

Foster Care/Adoption Care Assistance

Children for whom the Dept of Children and Family Services has legal responsibility are eligible for Medicaid.

Title IV-E eligible foster children/adoption assistance from other states who are living in Illinois

Medical Assistance coverage is provided through this program and the other state provides the adoption or foster care cash assistance payment.

Non-U.S. Citizens

Must meet the eligibility requirements of any category.

Non-citizens who do not meet immigration requirements (undocumented) are only eligible for coverage for emergency services.

Temporary Assistance for Needy Families (TANF)

Families with children.

A person who qualifies for TANF income assistance also meets the qualifications for the Medical Assistance Program.
Current TANF income limits vary according to county grouping.  There are three groups.  The current income limits for a family of four with an adult in the household are:
Group I counties: $435
Group II counties: $423
Group III counties: $408

Asset limits:
$2,000 for one person
$3,000 for two people
$50 for each additional person

There are some deductions that are used to arrive at “countable” income.

Medically Needy (Spenddown)

Family Health Spenddown

Income limits:
Family of one: $283
Family of two: $375
Family of three: $508
Family of four: $558

No asset limit.

The participant’s spenddown obligation is determined on a monthly basis and is based on income.

When spenddown is met in the middle of a month, the decision as to which bills are the patient’s responsibility and which are the Department’s is made chronologically based on date of service.

Elderly/Disabled

Recipients of Supplemental Security Income (SSI)

Must apply for Medicaid.  Illinois is a 209(b) state.
Current SSI payment levels:
$564 single
$846 couple

Eligibility for SSI is determined by the Social Security Administration.

A 209(b) state is a state that opted to continue to use the Medicaid eligibility standards it had in place when SSI was enacted in 1972. Those policies are generally more restrictive than the SSI eligibility rules.

Aid to the Aged, Blind and Disabled (AABD) Medical – Non SSI

Must be 65 years of age or older, blind or disabled.
Income cannot exceed 100% of FPL (currently $776 for one person and $1,041 for two people).
Asset limit: $2,000 for one person and $3,000 for two people

Health Benefits for Workers with Disabilities (HBWD)

Must be age 16 through 64.
Income cannot exceed 200% of FPL.
Asset limit:  $10,000

Assists individuals with disabilities who wish to go to work or to increase their earnings without the fear of losing Medicaid benefits.

Qualified Medicare Beneficiary (QMB)

Income cannot exceed 100% of FPL.
Asset limit:  $4,000 for one person and $6,000 for two people

Medicaid pays Medicare premiums, deductibles and coinsurance.

Specified Low Income Medicare Beneficiary (SLIB)

Income must be greater than 100% of FPL but cannot exceed 120% of FPL.
Asset limit: $4,000 for one person and $6,000 for two people.

Medicaid pays Medicare Part B premium.

Qualified Individual (QI-1)

Income must be greater than 120% of FPL but cannot exceed 135% of FPL.
Asset limit: $4,000 for one person and $6,000 for two people.

Medicaid pays Medicare Part B premium.

SeniorCare

Income cannot exceed 200% of FPL.
No asset limit.

This is a prescription drug assistance program for individuals age 65 and older.

SeniorCare pays up to $1,750 per person per year with copayments linked to income.  After $1,750, clients pay 20% of the cost of the each prescription plus applicable copayments.

Individuals must reapply every year.

If an individual has health insurance with pharmaceutical benefits, he/she may choose to sign up for the SeniorCare rebate.  This provides a $25 rebate check every month.

SCHIP

KidCare

·         Share

·         Premium

Income between 133% and 150% of FPL.
Income between 150% and 200% of FPL.

The KidCare Share program has copayments for certain services ($2 for all visits and prescriptions up to a maximum of $100 per year per family).
The KidCare Premium program has a monthly premium and copayments for certain services ($5 for all visits, $25 for emergency room visits in a non-emergency, $3 for generic drugs and $5 for brand name prescriptions up to a maximum of $100 per year per family).

Children in American Indian or Alaska Native families do not have copayments.

Providers are not required to collect copayments.

In addition, there is a plan called KidCare Rebate that is available to families between 133% and 200% of FPL whose children are uninsured.  KidCare Rebate reimburses a part of the cost for private health insurance for children.