Work Incentives Working Group

State Public Benefits Manual

Returning to Work:
Questions and Answers for People Recieving SSI and/or SSDI

 

State Public Benefits Manual

CHAPTER THREE
STATE ADMINISTERED BENEFITS

This chapter reviews the assistance programs administered by the Illinois Department of Human Services (IDHS) that are available to low-income persons and families.

Persons with psychiatric disabilities will often need to apply for assistance and help in applying and negotiating the DHS system. As discussed below, there are several different programs that may provide cash assistance, medical assistance and food benefits.

Generally speaking, IDHS provides three different types of benefits: cash assistance, medical assistance and food assistance (Food Stamps are discussed in Chapter Seven).

Workers assisting persons with mental impairments do need to be aware that, in Illinois, persons must fit into certain categories to receive cash and/or medical assistance benefits. Just being poor is not enough; a person must also fit into a covered category (e.g. parent or child in family, elderly, disabled or pregnant) to qualify for benefits.

When a person or family applies for benefits from the Illinois Department of Human Services local offices (list of local offices is contained in the Appendix), IDHS staff are required to assess the eligibility under all the various cash, medical and food assistance programs.

This chapter reviews the eligibility criteria for the cash and medical assistance programs. Generally, persons and families receiving cash assistance will get medical assistance as well. All of these programs look at three different areas in determining eligibility -- whether the person or family is categorically eligible (e.g., do they fit into the categories for which benefits are available, such as, children or persons with disabilities); whether the person or family are U.S. citizens or fall into one of the groups of eligible immigrants; and whether the person or family is financially eligible (does their income and resources fall below the eligibility levels).

A. CASH ASSISTANCE PROGRAMS

1. AID TO THE AGED, BLIND, OR DISABLED (AABD)

The AABD program provides cash assistance to persons who are elderly, blind, or disabled. The disability standard is the same standard used by the Social Security Administration. Generally speaking, persons may only receive AABD benefits if they have been found eligible for SSI previously or if they were denied SSI because they or their spouse had too much monthly income.

AABD benefits are not available to persons who have applications pending for SSDI and/or SSI. Individuals living in Chicago may be eligible for P3 or TA benefits while they are waiting to be found qualified for SSDI or SSI. (See pages 47-50 for TA & P3). Persons living outside of Chicago, who have pending SSDI and SSI applications, may be eligible for Township Assistance (See Chapter Six).

Finally, legal immigrants who are 65 or older who are found "not disabled" by SSA are eligible for AABD benefits. See p.46.

Categorical Eligibility:

To be eligible for AABD cash assistance, the individual must fall into one of the following categories:

  • Age 65 or older;
  • Blind; or
  • Disabled.

To receive AABD based on disability, the individual must meet the SSA definition of disability. The disability finding may be made by the Social Security Administration or by the Client Assessment Unit (CAU) of the Illinois Department of Human Services.

IDHS will only pay AABD benefits based on disability to individuals who are receiving SSI benefits or who were denied SSI due to excess income. SSA's disability definition is controlling; an individual found not disabled by SSA cannot get a new decision from IDHS to qualify for AABD benefits. However, if a person is denied SSI because of excess income, he or she would have disability status determined by CAU as part of the AABD determination.

Citizenship
AABD benefits are only available to U.S. citizens and eligible immigrants. See the Immigrant Eligibility Chart in the Appendix that explains which immigrants are eligible for public benefits.

Income Eligibility
Persons qualify for AABD cash assistance if their total needs exceed allowable nonexempt income by at least $1. The budgeting methodology used for AABD is exceedingly complex. First, IDHS calculates the amount of countable income that an individual has. Next, IDHS calculates the individual's needs. IDHS considers such needs as housing, food, clothing, utilities, and other costs.

However, costs are capped; for example, the maximum housing monthly deduction allowed is $97 -- far less than most persons pay monthly for housing. Other costs such as food, utilities and clothing are capped at amounts far lower than most persons require to live on.

There is no maximum monthly grant as the amount is based on comparison of income and expenses. The average monthly AABD grant, based on October 2000 data, was approximately $68.

The AABD budgeting methodology is set forth on the internet at:
www.lafcchicago.org


Resource Eligibility
Individuals must have countable resources below $2000 to qualify for AABD. Couples residing together must have countable resources below $3000.

IDHS excludes many items in determining resource eligibility. Among items that are not counted are:

  • the individual's home (so long as he or she resides in it; however, DHS will place a lien against the home);
  • household goods and personal effects so long as their total equity value does not exceed $2000; and
  • an automobile regardless of value if needed for employment, transportation for medical treatment, if required for a handicapped person, or if needed for essential daily activities because of climate, remoteness, etc. If none of these factors is shown, the vehicle is exempt if its current value does not exceed $4,500.

Special AABD Cash Assistance for Legal Immigrants 65 and Older
As a result of welfare reform, legal immigrants who legally resided in the United States on August 22, 2022 are only eligible for SSI benefits if they are disabled, even if they are 65 years old or greater.

To assist elderly immigrants who were lawfully here prior to August 22, 1996, but who are not disabled, Illinois provides cash benefits (approximately the SSI payment level).

To Be Eligible For This AABD Category, an individual

  • Must have legally resided in the U.S. on August 22, 1996;
  • Must meet non-citizen requirements for medical assistance;
  • Must be 65 years of age or older;
  • Be found not eligible for SSI due to a determination of "not disabled."

How To Apply
Applications should be made to the Illinois Department of Human Services local office for AABD Cash Assistance.

2. TRANSITIONAL ASSISTANCE(TA) - AND P3 (City of Chicago only):

Transitional Assistance (TA) and P3 are means-tested cash assistance programs that pay monthly benefits to persons residing in the City of Chicago and receiving townships (townships that adhere to IDHS rules in determining eligibility for welfare benefits). Both "regular TA" and TA P3 provide a monthly benefit of $100. However, as is discussed below, regular TA comes with GA Medical while TA P3 comes with Medicaid - which has a better medical assistance coverage package (See Chapter Four). Because of this important difference, P3 eligibility is discussed separately in this section.

Unlike AABD, TA and P3 are available only to single individuals who have not been found eligible for SSI from the Social Security Administration based on being age 65 or older, blind, or disabled. However, persons who have applied for SSI, but who are waiting for a favorable decision on SSI eligibility may apply for and receive either P3 or TA benefits.

CATEGORICAL ELIGIBILITY

P3 Eligibility
To be eligible for P3, an individual must:

  • have a pending application for SSI disability benefits;
  • be found disabled by the IDHS Client Assessment Unit (CAU);
  • be a U.S. citizen or eligible immigrant; and
  • meet income and asset requirements.

The disability standard used by CAU is the same as the standard used by SSA.

TA ELIGIBILITY

If the individual is not found eligible for P3 or if he/she does not have a pending SSI application, IDHS will assess eligibility for TA. To be eligible for TA, an individual must be found "not employable," which means that she or he falls into one of the following categories:

  • age 55 or older and has not had gross earnings totaling $2,000 or more in the past year, and has not earned at least $200 per month in seven of the preceding 12 months; or
  • required to regularly take prescription medications to control seizures, severe high blood pressure, or diabetes; or
  • needed at home to provide full-time care for someone living in their home due to that person's medical condition; or
  • under the age of 20 and in full-time attendance in high school or the equivalent vocational or other training school; or
  • homeless due to a court-ordered evacuation, domestic violence, fire, or natural disaster within the last six months (evictions for nonpayment of rent is not covered --TA is available only for 6 months); or
  • temporarily ill or incapacitated -- TA is available only for the period of illness or incapacity.

CITIZENSHIP

P3 and TA benefits are available only to U.S. citizens and eligible immigrants. See the Immigrant Eligibility Chart in the Appendix.

INCOME

The maximum TA or P3 benefit for a "non-employable" adult is $100 per month. IDHS counts an individual's income in determining the actual payment amount, which cannot exceed $100.

In determining countable income for comparison to the monthly $100 maximum, individuals are allowed a $75 income disregard for employment expenses. In addition, individuals are allowed an employment deduction of $332 for any 3 months in a 12 consecutive month period.

TA and P3 recipients may also be eligible for additional payments for special needs. Among special needs that a TA recipient may receive is a transportation allowance to cover the costs of transportation to a drug or alcohol treatment or rehabilitation program. The allowance is not provided if transportation can be provided without charge by relatives, friends, or services, and the individual is expected to use any cost-free mode of transportation in the community. A special allowance is allowed for therapeutic diets required by persons with diabetes.

ASSETS

An individual is ineligible for TA or P3 if she or he has countable assets over allowable limits. The asset limits are $2000 for one person, and $3000 for two persons (so long as other individual is legally responsible, i.e. a spouse), and $50 for each additional person in the household.

IDHS excludes many items in determining asset eligibility. Among items that are not counted are the individual's home (so long as he or she resides in it); household goods and personal effects; and an automobile.

Advocacy Tips

  • TA applications can be filed at the IDHS district office in the client's neighborhood. The application will be handled by case-workers in the Intake Unit.
  • TA (other than P3) does not provide MEDICAID coverage, so try to help the individual client access other programs such as SSI, TANF, AABD first.
  • When individual applies for TA, make sure IDHS reviews all the possible categories in which a client could be found "not employable." Thus, if IDHS denies someone's TA application because they are not eligible in the SSI-related category, make sure IDHS also considers them for the other categories that might apply, such as the age 55 category, or providing full-time care to another person category.
  • All TA recipients who live in Chicago can receive free paralegal help with their initial SSI applications and requests for reconsideration from the SSI Advocacy Project at 312/427-5200 or 1-800-824-4050.

3. TEMPORARY ASSISTANCE TO NEEDY FAMILIES (TANF)

The Temporary Assistance to Needy Families program (TANF) was created in 1996 by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 to replace the Aid to Families with Dependent Children program (AFDC).

Persons with psychiatric disabilities often rely on TANF benefits to support their families. Many such persons rely on TANF because they have applied for SSDI and/or SSI disability benefits and been denied, or because they have pending SSDI/SSI disability applications. As a result, OMH workers should have a basic understanding of how TANF operates.

Persons with psychiatric disabilities face two major issues when they receive TANF benefits as a parent.

First, almost all parents in TANF families are now required to participate in work and/or educational activities for a set number of hours each week, with a goal of transitioning to full-time employment.

Second, TANF benefits are time-limited. Most parents are limited to receiving TANF for only 60 months.

Both requirements may create problems for parents with psychiatric disabilities who receive TANF.

TANF FAMILY COMPOSITION

To be eligible for TANF, a family unit requesting benefits must contain the following:

  • Child (person under age of 18, or age 18 and attending secondary school full-time); and
  • Caretaker Relative -- parent, person married to parent, relative, person married to relative, or unrelated person (if the family is already receiving TANF benefits and the caretaker relative dies or leaves - assistance may be paid to the unrelated person for up to 90 days); OR
  • Pregnant Woman, and her spouse, if in the home.

The TANF family unit cannot contain persons who are receiving SSI benefits. Persons receiving Social Security benefits, or other governmental disability benefits (veteran's benefits, Railroad retirement benefits, Black Lung benefits) are included if their benefits are less than the TANF grant would be.

BACK TO TOP

INCOME RULES

IDHS counts income--money received during any month in which TANF is requested in determining whether a family is needy enough to qualify for TANF. IDHS counts the income of all persons included in the TANF unit, and it counts the income of stepparent or parent who is not included in the TANF unit.

IDHS counts only $1 out of every $3 of earned income in determining TANF eligibility.

IDHS counts all other income that is not earned as wages or salary from job or profits from self-employment. IDHS counts every dollar of unearned income in determining TANF eligibility.

However, some unearned income is not counted at all in determining TANF eligibility. Some examples of exempt or not counted income are:

  • disability payments of a parent (e.g., Social Security, veteran's, and Railroad Retirement Benefits) up to the SSI maximum payment level of $530 in 2001 may be exempt;
  • Payments under the Family Assistance Program for Mentally Disabled Children;
  • Loans from someone not legally responsible for support of the family;
  • SSI lump sums for the month of receipt and the next month;
  • Other benefits such as Low-Income Home Energy Assistance Program, Section 8 housing benefits;

Lump Sums–lump sums are either onetime payments that do not recur, or retroactive payments of recurring income, such as unemployment compensation (e.g., personal injury or workers' compensation settlements, lottery winnings, insurance settlements, or inheritances). Some lump sums are not counted (they are listed immediately above in the exempt income section). The others may lead to loss of TANF eligibility for multiple months.

PAYMENT LEVELS FOR TANF (October 2000)

(TANF and GA-FCA with Adult in Unit/No Adult)

1 Person

Group I Counties
$212/$165 ($102)
Group II Counties
$204/$160 ($97)
Group III Counties
$173/$154 ($94)

2 People

Group I Counties
$278 ($201)
Group II Counties
$269 ($194)
Group III Counties
$257 ($188)

3 People

Group I Counties
$377 ($249)
Group II Counties
$365 ($242)
Group III Counties
$349 ($237)

4 People

Group I Counties
$414 ($319)
Group II Counties
$403 ($311)
Group III Counties
$389 ($302)

5 People

Group I Counties
$485 ($379)
Group II Counties
$471 ($369)
Group III Counties
$453 ($359)

6 People

Group I Counties
$545 ($407)
Group II Counties
$529 ($397)
Group III Counties
$511 ($387)

COUNTY GROUPINGS

Group I Counties

Boone, Champaign, Cook, DeKalb, DuPage, Kane, Kankakee, Kendall, Lake, McHenry, Ogle, Whiteside, Winnebago, Woodford

Group II Counties

Adams, Bureau, Carroll, Clinton, Coles, DeWitt, Douglas, Effingham, Ford, Fulton, Grundy, Henry, Iroquois, Jackson, JoDaviess, Knox, LaSalle, Lee, Livingston, Logan, Macon, Macoupin, Madison, McDonough, McLean, Mercer, Monroe, Morgan, Moultrie, Peoria, Piatt, Putnam, Rock Island, Sangamon, St. Clair, Stephenson, Tazewell, Vermilion, Wabash, Warren, Will

Group III Counties

Alexander, Bond, Brown, Calhoun, Cass, Christian, Clark, Clay, Crawford, Cumberland, Edgar, Edwards, Fayette, Franklin, Gallatin, Greene, Hamilton, Hancock, Hardin, Henderson, Jasper, Jefferson, Jersey, Johnson, Lawrence, Marion, Marshall, Mason, Massac, Menard, Montgomery, Perry, Pike, Pope, Pulaski, Randolph, Richland, Saline, Schuyler, Scott, Shelby, Stark, Union, Washington, Wayne, White, Williamson

ASSETS

Assets are the real estate and other property owned by the family, such as a home, car, or bank account. The value of a non-monetary asset is its "equity value," which is the fair market value minus the amount owed for the asset. Families are not eligible for TANF if their countable assets exceed certain amounts. However, as is discussed below, many assets are not counted in determining TANF eligibility.

Asset Limits–The asset limit for a one person family is $2,000, for a two person family is $3,000 and for families with three or more persons, $3,000 for the first two persons plus $50 for each additional person. If countable assets exceed the TANF limit, the family is ineligible for TANF.

Exempt Assets–The following assets are not counted in determining TANF eligibility:

  • House and adjoining land that is the dwelling where the TANF family usually lives;
  • One automobile;
  • Personal items such as clothing, personal effects, and household furnishings;
  • Burial plots plus up to $1,500 per person of prepaid funeral expenses;
  • Donations from fund-raisers for seriously ill persons as long as family does not control funds or their distribution;
  • SSI lump sums for the month of receipt and the next month;
  • Assets of stepparent;
  • Savings accounts containing only earnings of child and gifts of no more than $50 per calendar quarter; and
  • Funds held in Individual Development Account.

TANF EMPLOYMENT AND WORK ACTIVITIY REQUIREMENTS

One of the major changes in the shift from AFDC to TANF was that almost all parents in TANF families are now required to engage in work and/or educational activities that will enable full-time employment in the future.

Generally speaking, a one-parent family parent must be working, or in a work activity, at least 30 hours weekly, and a two-parent family must be working, or in a work activity, at least 35 hours weekly to receive TANF benefits. There are some exceptions to these rules.


THE 60-MONTH LIFETIME LIMIT ON RECEIPT OF TANF BENEFITS

All adult recipients of TANF are limited to receiving 60 months of TANF in their lifetimes. Any month in which an adult receives TANF counts against the time limit except as noted below. The months do not have to be consecutive, but accumulate during several periods on TANF. The 60-month clock ticks whenever benefits are paid, whether the adult is participating in work and training activities, or is excused from participation in those activities. After receiving aid for 60 months, an adult not only is ineligible for life but so is any of her children with whom she lives. The time limit does not apply to children who do not live with the parent who has received 60 months of TANF, so children whose parent reaches the 60-month limit may continue to receive TANF only if they live with another relative.

IDHS did not start counting months for the 60-month lifetime limit until July 1997. Thus, the first month in which a family could lose TANF benefits because of the 60-month rule is July 2002 if they have received TANF only in Illinois. However, if an adult received TANF in another state which started its TANF program sooner than Illinois, the parent could lose benefits sooner (as early as October 2001).

There are exceptions to this rule. A month is not counted in a 60 month total if:

  • in a one parent family, a parent works in paid employment an average of at least 30 hours per week (effective October 1, 2021) during the month;
  • in a two parent family, the parents work in paid employment an average of 35 hours per week during the month; or
  • in a one parent family, parent attends a college degree program full-time and has at least a 2.5 (out of 4) grade point average.

In addition, federal law allows Illinois to grant families "hardship exemptions" and continue paying benefits to such families even though the parents have already received TANF for 60 months so long as no more than 20% of all families receiving TANF in Illinois are "hardship exemptions." Illinois has not yet defined any "hardship exemptions." However, as noted above, the first month in which this rule might apply for most families is July 2002.

4. GA FAMILY AND CHILDREN ASSISTANCE(FCA)

A family that does not qualify for TANF may be eligible for GA Family and Child Assistance. A family cannot receive FCA if they are ineligible for TANF because they failed to cooperate with the Illinois Department of Human Services or because they received a lump-sum payment that precludes TANF eligibility. The income payment levels are set forth above in the table that describes TANF payment levels.

B. MEDICAL ASSISTANCE PROGRAMS

Persons and families who get cash assistance from IDHS (under any of the programs discussed in the prior section also qualify for medical assistance.

There are two types of medical assistance available: Medicaid and GA Medical. Medicaid covers far more services and items than does GA Medical. See Chapter Four for comparison of Medicaid and GA Medical.

Below shows the corresponding medical assistance program for each cash assistance program.


AABD Medicaid
P3 Medicaid
Regular TA GA Medical
TANF Medicaid
TA-FCA GA Medical for Adults/Medicaid for Children
TA P3 Medicaid

In addition, persons and families who do not qualify for cash assistance and the corresponding Medicaid coverage can qualify for medical assistance only. See the Appendix for a client handout

Generally, people receive medical assistance only from IDHS in two circumstances:

  • Persons receiving cash assistance from another source such as Social Security or SSI may qualify for medical assistance; and
  • persons in families with income that makes them ineligible for cash assistance from IDHS may qualify for medical assistance because the income limits are higher.

WHO IS ELIGIBLE FOR MEDICAID?

To be eligible for Medicaid, an individual must fall into one of the following categories:

Aged, Blind and Disabled (AABD)

  • Persons age 65 and older
  • Persons with disabilities (using SSA definition of disability)
  • Persons who are blind
    - AABD MANG (for all groups)

Families

  • children under age of 19
    - Kidcare
  • pregnant women (coverage continues 60 postpartum)
    - KidCare
    - KidCare Moms and Babies Plan
  • caretaker relatives (e.g. parents, other adult relatives) living with child or children under the age of 19, or of pregnant women
    - ParentAssist

Workers assisting clients with mental impairments should review the eligibility categories carefully. Assuming that the client is a U.S. citizen or eligible immigrant, he or she is potentially eligible for Medicaid if he or she fits into one of the categories set forth in the table.

In addition to fitting into one of these categories, persons must also meet the citizenship requirement and the income and asset limits. The program eligibility criteria for the two broad groups are discussed below.

1. Medical Assistance for the Aged, Blind and Disabled

Persons who are 65 or older, blind or disabled may qualify for Medicaid under the AABD MANG (Medical Assistance No Grant) program.

NOTE: In Illinois, individuals who receive SSI benefits are not automatically eligible for Medicaid eligibility. Instead, they must apply for AABD-MANG with the Illinois Department of Human Services. SSI benefits are not counted under AABD MANG income rules, except for persons living in long-term care facilities or supportive living facilities. Additionally, there are different rules for persons living in long-term care facilities (e.g. nursing homes) or supportive living facilities (SLFs). See page 65-66 for discussion).

Income Limits for AABD-MANG
To get Medicaid under the AABD MANG program, a person's monthly income must fall below certain levels. To qualify for "regular" or continuous Medicaid coverage, countable income must fall below the amounts in the table on the next page. MEDICAL COSTS ARE NOT CONSIDERED IN DETERMINING REGULAR MEDICAID ELIGIBILITY.

AABD - MANG Monthly Countable Income Standards

Number in Family – 1
Monthly Countable Income
Through 6/30/01
$501
Monthly Countable Income
On or After 7/01/01
$608

Number in Family – 2
Monthly Countable Income
Through 6/30/01
$677
Monthly Countable Income
On or After 7/01/01
$822

Number in Family – 3
Monthly Countable Income
Through 6/30/01
$853
Monthly Countable Income
On or After 7/01/01
$1036

Number in Family – 4
Monthly Countable Income
Through 6/30/01
$1030
Monthly Countable Income
On or After 7/01/01
$1250

Persons whose monthly income is above this standard may still be able to qualify.

***Note: On May 8, 2000, Governor Ryan signed into law HB 3872, which among other things raises the income limit for AABD-MANG. As a result, the AABD-MANG limits increase to 70% of the federal poverty level (FPL) on July 1 2000; 85% of the FPL on July 1, 2001; and 100% of the FPL on July 1, 2002. These income limits will also be adjusted slightly higher in February or March 2001 to reflect increases in the federal poverty levels.

Rules For Determining Countable Income

  • SSI Income is not counted. However, Social Security income is counted.
  • A $25 deduction from income is allowed.
  • Income of family members is not considered available to an AABD MANG applicant except for income of the spouse of the applicant (if they live in the same household) or a parent of a child who is under 18.
  • There are other deductions from earned income (e.g., wages) of the applicant, spouse, or parent(s) (if applicant is under the age of 18). Impairment Related Work Expenses (IRWE's) and PASS deductions are not counted (see Chapter Two for information).

Asset Limits for AABD MANG

To be eligible for AABD MANG coverage, the applicant's countable assets must fall below the limits set forth in the following table.

Number in Family – 1
Countable Asset Limits $2,000

Number in Family – 2
Countable Asset Limits $3,000

3 or more persons
Countable Asset Limits $3,000 for first two persons, plus $50 for each additional person

In determining the total amount of assets available to an AABD MANG applicant, IDHS uses the assets of any person in the home who is legally responsible for the client, such as a spouse. IDHS may not consider the resources of any person in the home who is not legally responsible, such as the client's child.

Persons whose assets are above these standards may still be able to qualify for Medicaid under the spenddown program discussed in Chapter Four.

The following assets, among others, are considered exempt and are not countable:

  • the individual's home, if he or she resides in it;
  • household goods and personal effects, if their total equity value does not exceed $2,000; and
  • an automobile is exempt regardless of the value if needed for employment, transportation for medical treatment, if modified for a handicapped person, or if needed for essential daily activities because of climate, remoteness, etc.; or if none of these factors is shown, if its current market value does not exceed $4,500.

Immigrant Eligibility for AABD MANG

As with the cash assistance programs, all U.S. citizens and some immigrants are potentially eligible.

The Immigrant Eligibility Chart in the Appendix, outlines which immigrants may qualify for AABD MANG.

2. MEDICAL ASSISTANCE FOR FAMILIES, PREGNANT WOMEN, AND KIDCARE

Medicaid for Parents in Families

Caretaker relatives and their spouses in families not receiving TANF can qualify for Medicaid coverage under the Parent Assist program. Generally, as discussed below, the income limits are fairly low and are identical to those used for the elderly and persons with disabilities under the AABD MANG program. However, parents with income that puts them over the Parent Assist income levels may still be able to qualify for Medicaid if their medical bills are high enough. See discussion of spenddown in Chapter Four.

Parent Assist Monthly Countable Income Standards (as of 12/99)

Number in Family – 1
Monthly Countable Income $283

Number in Family – 2
Monthly Countable Income $375

Number in Family – 3
Monthly Countable Income $508

Number in Family – 4
Monthly Countable Income $558

Unlike the AABD-Mang income standards discussed on pg. 59, these standards do not increase annually.

There are no assets limits.

Only U.S. citizens and certain immigrants are eligible for coverage. The Immigrant Eligibility Chart in the appendix outlines which immigrants may qualify for Parent Assist.

Medicaid for Pregnant Women and their Newborn Children

In addition, pregnant women can qualify for Medicaid to cover the expenses of prenatal care, labor and delivery, and postpartum care (for 60 days). The newborn children can qualify for Medicaid for up to a year. After the first year, children will continue to be eligible for Medicaid if they qualify under the KidCare program described below.

Moms and Babies Monthly Countable Income Standards (as of 1/2000)

Number in Family – 1
Monthly Countable Income —

Number in Family – 2
Monthly Countable Income $1938

Number in Family – 3
Monthly Countable Income $2438

Number in Family – 4
Monthly Countable Income $2942

Number in Family – 5
Monthly Countable Income $3446

Pregnant women count as two persons (unless the women is carrying multiple children - e.g. a pregnant women carrying twins counts as three persons).

Pregnant women and newborn children (up to 1st birthday) are eligible for Medicaid so long as their countable incomes are at 200% of the federal poverty levels or less.

There are no asset limits.

All pregnant women, regardless of immigration status, are potentially eligible for Medicaid. Thus, even undocumented immigrants are eligible for Medicaid coverage if pregnant. See the Immigrant Eligibility Chart in the Appendix.


KidCare

Children, up to age 19, can qualify for Medicaid coverage under the KidCare program. KidCare provides the same covered services as Medicaid. In addition, families who have private health insurance coverage for their children may also qualify for payment of rebates for premiums paid to maintain the children's health insurance coverage. In this situation, the Department does not pay the children's medical expenses.

Who is eligible for KidCare--Children in Illinois may qualify for KidCare Share and Premium coverage if they are:

  • under age 19;
  • U.S. citizens, or certain immigrants (See Immigrant Eligibility Chart in the Appendix) (generally, Illinois is more liberal in extending Medicaid to kids than adults);
  • not covered under a private or employer based insurance plan during the three months preceding making KidCare application, and not eligible for health benefits under a State of Illinois health benefits plan on basis of family member's employment with a state agency; and
  • their countable family incomes are below the eligibility standards set forth below (maximum countable income is 185% of federal poverty level).

Families of children who are covered under a private or employer based insurance plan may be eligible for reimbursement for some of the costs of that care.

Different Plans Available Under KidCare – Illinois provides the following plans under KidCare. The types of services covered by all the Plans, other than the KidCare Rebate Plan, are the same. Covered services are detailed in Chapter Four.

The major difference between the plans is the cost to families. Families at higher income levels are required to make co-payments, and in some instances, monthly premiums to receive KidCare. The KidCare Rebate Plan also provides an insurance rebate to families whose income levels fall below the requirements, but who already have health insurance coverage for their children in employer sponsored or private insurance. The rebate program is discussed below.

  • KidCare Assist Plan – this plan pays for children's health care as well as health care for parents in some circumstances. There are no co-pays or premiums. This Plan is also called Medicaid.
  • KidCare Share Plan – this plan also pays for children's health care. Parents are required to make co-payments for doctor, clinic, and hospital visits, or for prescriptions. There are no co-payments required for immunizations and well-child care.
  • KidCare Premium Plan – this plan pays for children's health care, but requires parents to pay monthly premiums as well as make co-payments for doctor, clinic, and hospital visits, or for prescriptions. There are no co-payments required for immunizations and well-child care.
  • KidCare Rebate Plan – this plan provides reimbursement to families for the cost of children's health insurance that the family already has.

Countable monthly and yearly income limits are set forth for the various plans below. Family size includes any parents living in the household and all children under age of 18.


Call IDPA's KidCare Hotline, 1-800-226-0768, for income levels for larger families.

What Is The KidCare Rebate Plan

If children are covered under a private or employer based health plan, their families may qualify for monthly reimbursement for part of the cost of that health insurance. The amount of reimbursement per child covered under the private or employer based health plan currently is the lesser of $75 or the policyholder's monthly portion per child of the premium paid.

How To Apply for KidCare

Families can request a KidCare application by calling 1-800-226-0768 (1-877-204-1012, TTY). In addition, the KidCare application is available on the Internet at www.kidcareillinois.com.

Medicaid for Families Losing TANF or GA Family and Child Assistance (FCA)

Families canceled from TANF or GA Child and Family Assistance may be eligible to receive up to 12 months of medical assistance (Medicaid for TANF families and children in GA - FCA households; and GA Medical for parents in GA - FCA households) if they are canceled because:

  • a family member(s) has gone to work and the wages make the family ineligible;
  • the family is receiving child support; or
  • the family fails to respond to the New Hire list;

3. MEDICAL ASSISRANCE FOR NURSING HOME CARE

Medicaid will pay for nursing home services for eligible individuals. In order to qualify for Medicaid to cover nursing home services, an individual must first obtain a doctor’s certification that he/she should live in a nursing home, or continue to receive care in a nursing home, and obtain a needs screening by the Illinois Department on Aging or the Illinois Department of Human Services (IDHS). The needs screening will help determine if placement in a nursing home is the best choice for the individual, or if alternative home and community-based services could be more appropriate.

Once an individual files an application for Medicaid for nursing home services, IDHS will determine how much of the individual’s own income must be paid to the nursing home each month. An individual will be able to keep $30 each month for personal needs.

If the individual in the nursing home has a spouse, dependent children under age 21, dependent adult children, dependent parents or dependent brothers or sisters of either the individual or the community spouse, IDHS will make deductions from that individual’s income (if any) to allow that income to be provided to family members living in the community.

If the individual is married, IDHS will allow the spouse who is not in the nursing home (the community spouse) to keep the marital home, a car and the household furnishings. IDHS will then determine the value of all the other assets.

There is no limit on the amount of assets the community spouse may have. If the community spouse's assets are in excess of the maximum amount, the resident may not transfer any additional funds. The individual in the nursing home may transfer property to the community spouse to bring the assets up to the asset level $84,120 in 2000). All assets above that amount will have to go to the nursing home to pay for the nursing home care.

If, in anticipation for applying for Medicaid to cover nursing home services, an individual transfers property for less than fair market value, IDHS will penalize the individual for the uncompensated value of the transferred property. IDHS will look back 36 months before application for Medicaid, or 36 months before entry into the nursing home, at an individual’s assets. If IDHS determines that there was an improper transfer, the penalty begins with the month of the transfer and continues for as long as the uncompensated value of the transferred property would meet the monthly cost of nursing care at the private rate.

The State of Illinois has the right to recover the amount of assistance persons receive through the Medicaid program. The State can file a lien on any real property an individual owns and a claim against their estate and the estate of the deceased spouse. The State will seek to recover the money equal to the amount of Medicaid the individual received.

Individuals in nursing homes have certain rights that are protected under federal and state law. For instance, they have the right to receive the care they need, to return to the nursing home after a hospital stay, the right to keep and manage their money (the $30/month), the right to privacy, and the right to complain. [Problems or complaints about nursing homes can be made to the Illinois Department of Health at 800.252.4343, or the Nursing Home Ombudsman at 800.252.8966.]

 

BACK TO TOP

CHAPTER ONE
SOCIAL SECURITY DISABILITY PROGRAMS

CHAPTER TWO
HOW TO WORK AND MAINTAIN SOME SSDI OR SSI BENEFITS

CHAPTER THREE
STATE ADMINISTERED BENEFITS

CHAPTER FOUR
HOW THE MEDICAL ASSISTANCE PROGRAMS WORK

CHAPTER FIVE
MEDICARE

CHAPTER SIX
OTHER STATE AND LOCAL PROGRAMS THAT PROVIDE CASH OR MEDICAL ASSISTANCE

CHAPTER SEVEN
FOOD STAMPS

CHAPTER EIGHT
OFFICE OF REHABILITATIVE SERVICES (ORS)

CHAPTER NINE

OTHER BENEFITS AND/OR PROTECTIONS