a)
Eligibility for medical assistance exists when a person meets the non-financial
requirements of the program and the person's countable nonexempt income (see
Sections
120.64,
120.330 and
120.360) is equal to or less
than the applicable Medical Assistance - No Grant (MANG) standard and, for AABD
MANG, countable nonexempt resources are not in excess of the applicable
resource disregards (Section
120.382). Persons receiving
basic maintenance grants under Article III or IV of the Public Aid Code are
eligible for medical assistance. Financial eligibility for medical assistance
for other persons living in the community is determined according to Section
120.60, unless otherwise
specified. Financial eligibility for medical assistance for persons receiving
long-term care services, as defined in Section
120.61(a), is
determined according to that Section, unless otherwise specified.
b) For AABD MANG, a person's countable income
and resources include the person's countable income and resources and the
countable income and resources of all persons included in the Medical
Assistance standard. The person's responsible relatives living with the child
must be included in the standard. The person has the option to request that a
dependent child under age 18 in the home who is not included in the MANG unit
be included in the MANG standard.
c) For applications received on or after
October 1, 2013, eligibility for pregnant women and children, as set forth in
Section
120.11,
120.12 and
120.14, and parents and other
caretaker relatives, as set forth in Section
120.32, shall be determined as
set forth in Section
120.64.
d) For AABD MANG, if a person's countable
nonexempt income is greater than the applicable MANG standard and/or countable
nonexempt resources are over the applicable resource disregard, the person must
meet the spenddown obligation determined for the applicable time period before
becoming eligible to receive medical assistance.
e) Effective January 1, 2014, for pregnant
women and children, if countable nonexempt income is greater than the
applicable standard, a child or pregnant woman must meet the spenddown
obligation determined for the applicable time period before becoming eligible
to receive medical assistance.
f) A
one month eligibility period is used for persons receiving long-term care
services (as defined in Section
120.61(a)).
Nonexempt income and nonexempt resources over the resource disregard are
applied toward the cost of care on a monthly basis, as provided in Section
120.61.
g) Newborns
1) When the Department becomes aware of the
birth of a child to a recipient of medical assistance, the child shall be
deemed to have applied for medical assistance, without written request, if the
mother had been receiving medical assistance on the date of birth of the
child.
2) The newborn shall be
eligible to receive medical assistance for a period of time as determined in
Section
120.400.
h) ACA Adults
Persons not otherwise eligible under this Section, who are
no younger than age 19 and no older than age 64 in households with income that
is at or below 133 percent of the Federal Poverty Level (FPL) are eligible for
medical assistance. Eligibility under this subsection (h) shall be determined
as set forth in Section
120.64, except that no coverage
for medical services under this subsection (h) shall begin prior to January 1,
2014. Notwithstanding any other provision of this Title 89, effective January
1, 2014, a person may not spend down to become eligible under this subsection
(h).
i) Former Foster Care
1) Persons who were in foster care are
eligible for former foster care medical assistance if they:
A) Are between ages 18 and 26;
B) Reside in Illinois;
C) Are no longer under the responsibility of
any state; and
D) Received medical
assistance under any state's Medicaid State Plan 470 or State Plan waiver when
they aged out of foster care.
2) No coverage for medical services under
this subsection (i) shall begin prior to January 1, 2014.
3) Persons who aged out of foster care
outside of Illinois are not eligible for former foster care medical assistance
under subsection (i) unless the person attained age 18 on or after January 1,
2023.
4) Notwithstanding any other
provision of this Title 89, effective January 1, 2014, a person may not spend
down to become eligible under this subsection (i).
