Dear Avisery Members,
T
he Illinois Department of Healthcare and Family Services (HFS) have posted multiple updates and temporary changes to Medicaid medical benefits in response to the COVID-19 emergency declaration. This Alert provides an overview of important updates that impact older adults and adults with disabilities in Illinois that are receiving or applying for Medicaid. A complete list of Medicaid updates can be found on the HFS website
here
a
nd the Illinois Department of Human Services (DHS) website
here.
Thank you to
HelpHub
for sharing many of these updates.
DHS Local Offices Closed to the Public
- Beginning April 16, DHS temporarily closed the remaining open local DHS office lobbies to the public after some staff working at those offices testing positive for COVID-19. Individuals can still apply for or manage their benefits online using ABE at
https://abe.illinois.gov/abe/access
and by phone using the
DHS hotline
(1-833-234-6343). DHS staff will be working remotely to process benefits and 1-800 ABE call center representatives will continue taking client calls throughout the state of Illinois. The DHS memo detailing the temporary office closures can be found
here.
Applying for Medicaid
Presumptive Eligibility
– Due to the COVID-19 health emergency, all new Adult Medicaid applications will be screened using criteria for presumptive eligibility (PE). If criteria are met, the applicant will be provided with presumptive eligibility for Medicaid and the full application will continue to be processed. This is done to ensure medical benefits are administered so applicants can promptly access health benefits during the crisis while the application is being processed. The cost of services provided to an applicant granted presumptive eligibility will not be recouped by HFS if the application is denied once the application is fully processed.
Adult applicants applying under Adult Medicaid and Family Care categories can be
eligible for presumptive eligibility. Applications will be screened to determine if the
applicant is an adult age 19-64, not receiving Medicare, income for their family size
at 138% or less of the federal poverty level, resident of Illinois, and a U.S. citizen or
have satisfactory immigration status. Individuals found eligible for PE status will not
receive a medical card until their entire application is processed and approved.
Please note that PE status will not be used to process AABD medical applications.
Temporary Medical Card
- Individuals who submitted medical applications that are pending for more than 54 days are still eligible to request a
temporary medical card, also
known as a “T Card”. Temporary cards allow individuals to receive temporary medical coverage if they applied for Medicaid, but have not had their application timely processed. This has been a process available before the COVID-19 emergency declaration and continues to be available. T Cards are not automatically provided and must be requested by the applicant. Temporary medical cards are valid until the application is approved or denied. Individuals are not required to pay back HFS for any services they received using a temporary medical card if their application is not approved. Please note that temporary medical cards do not cover long-term care services and supports. For additional information on how to request a temporary medical card, please visit
https://www.dhs.state.il.us/page.aspx?item=116876&newssidebar=30359. (
Please note that Medicaid FCRC DHS offices are currently closed, but individuals may still use the other methods listed in the resource sheet to request a T Card.)
Il
linois Client Enrollment Services
is back in service and can process Medicaid managed care plan changes and enrollments online or by telephone. Please note that MMAI plan enrollments and changes cannot be submitted online using
Illinois Client Enrollment Services
.
This has always been the case and MMAI plan enrollments and changes can continue to be submitted by calling Client Enrollment Services at 1-877-912-8880 or 1-800-MEDICARE.
Applying for Medicaid
– To simplify and quickly allow uninsured individuals, especially those affected by COVID-19, to be found eligible for Medicaid and access benefits, HFS is encouraging individuals to apply using ABE at
www.ABE.illinois.gov
. Individuals may also apply through mail, fax, or the ABE call center at (800) 843-6154, but note that wait times may be long.
At this time, HFS is urging applicants to answer all questions as completely as they
can, and to submit their applications even if they do not have all their verification
documents readily available to upload into ABE at the time of submission. Due to
the COVID-19 pandemic, HFS is currently accepting self-attestation statements for
new and pending medical applications for clients who do not have documentation
readily available for income, Illinois residency, insured status, and incurred medical
expenses such as bills and receipts (for Spenddown cases that are new or
pending). For more information for Medicaid verification and self-attestation
Uninsured individuals who need testing or treatment for COVID-19 should submit
their application using ABE and then send an email with the application tracking
number to HFS.Priority19@illinois.gov. HFS is encouraging counselors to assist
individuals in submitting an application even if they are unsure as to whether a
COVID-19 involved patient may be eligible for medical coverage. For more information,
Maintaining and Accessing Services
Medicaid Redeterminations and Terminations
- As of March 12, 2020, HFS and DHS stopped all Medicaid terminations and redeterminations. The Families First Act mandated all Medicaid terminations to be suspended during the COVID-19 crisis. Individuals on Medicaid should not have their coverage terminated unless they move out of the state of Illinois or if the client requests for Medicaid benefits to be canceled. Please see this
Families First Act Q&A
(question 6) for more information. HFS is currently prioritizing processing applications and reinstating individuals who were canceled but submitted redetermination documentation within the three-month time frame that allows for Medicaid coverage reinstatement.
HFS has stopped processing Medicaid redeterminations and will not terminate individuals who fail to respond to a redetermination during the COVID-19 emergency declaration. For more information, visit
https://www.medicaid.gov/state-resource-center/downloads/covid-19-section-6008-faqs.pdf
.
However, if an individual already received a redetermination notice prior to HFS stopping all redeterminations, the individual should still complete the notice and return it so their most current information is on file.
Temporary Pharmacy Policies Due to COVID-19
– Medicaid has made the following temporary changes to pharmacy coverage including temporary over-the-counter coverage for acetaminophen and cough suppressants, allowing prescribers not enrolled with Medicaid to write prescriptions for individuals eligible for Medicaid, moving select non-preferred drugs to preferred status in case of drug shortages, relaxing refill to soon edits, extending insulin fills to a 90-day supply, and more. For a complete list, please see the HFS provider notice
here
.
Medicaid Telehealth Services
- Medicaid has temporarily expanded telehealth services to include coverage in an individual’s home or any other site that allows a person to use a two-way audio and visual communication with a physician or qualified health care provider. The HFS provider notice can be
here.
Medicaid Spenddown
- Individuals who have met their Medicaid Spenddown in March 2020 or after will have their case kept in spenddown met status for every month until the national emergency ends:
https://www.dhs.state.il.us/page.aspx?item=123815.
Emergency Provider Program for DHS Home Services Program
– The Illinois Department of Human Services (DHS) and the Illinois Network of Centers for Independent Living (INCIL) together have launched the Emergency Provider Program to assist individuals in the DHS Home Services Program who experience an emergency with their in-home service provider because of the COVID-19 pandemic. Individuals who do not have a back-up provider to provide their Home Services can contact 1-800-587-1227 to be connected with an emergency provider. For more information, visit
http://www.dhs.state.il.us/page.aspx?item=123728.
Manage My Case and Identity Proofing
- There are no changes to the Identity Proofing process for the Manage My Case function available through ABE. Individuals who are unable to complete the Identity proofing process online, can manually submit their documentation by mail. Once the manual process has been completed and approved, their Manage My Case function may be operational before the client receives the approval letter, so it is recommended the client check back through ABE often. For more information and instructions on how to manually request identity proofing, visit
http://www.dhs.state.il.us/PAGE.ASPX?item=76721.
Medicaid Transportation and Required Documentation
- HFS has made temporary changes to required transportation documentation for Medicaid recipients during the COVID-19 national emergency. Prior approval is still required for non-emergency transportation, but effective March 1, 2020 the Physicians Certification Statement (HFS Form 2270) will not be required. These changes apply to individuals with Medicaid who are enrolled in fee-for-service, HealthChoice Illinois, or Medicare-Medicaid Alignment Initiative (MMAI) and will be in effect until the national emergency ends. For additional information, please view the HFS provider notice
here.
Additional COVID-19 Updates
Individuals who are displaying symptoms should contact their primary care doctor to determine if they should obtain a referral to be tested for COVID-19. Individuals who do not have a PCP can contact the Illinois Department of Public Health at (800) 889-3931. HFS is working to obtain federal approval to extend coverage to the uninsured for COVID-19 testing and treatment.
I
ndividuals who have lost qualifying health coverage through employment ending
, such as job-based insurance, may be eligible for a special enrollment period to enroll and purchase a Marketplace health plan. As a reminder, premium tax credits based on an individual’s household income are available to assist individuals pay for their plan’s premiums and cost sharing. For more information, visit
https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period/.
Illinois Call4Calm Text Line
- Illinois DHS has established a Call4Calm Hotline to assist and provide Illinois residents with mental and emotional support during the COVID-19 crisis. Individuals can text the hotline with their first name and zip code to be connected to a counselor near them (text TALK to 552020 for English or HABLAR for Spanish). The hotline is available free of charge, callers remain anonymous, and the service is available in English and Spanish. For more information, visi
t
http://www.dhs.state.il.us/page.aspx?item=123539.
