Illinois Medicaid and the End of Continuous Coverage FAQ

What is Medicaid?

Medicaid is a government-funded, comprehensive health insurance program that covers about 3.9 million people in Illinois, including low-income adults, children, pregnant women, and people with disabilities. It is jointly funded and managed through a partnership between the federal government and us at the Illinois Department of Healthcare and Family Services.

What is continuous coverage?

Congress made changes to Medicaid to help people and states deal with the Covid-19 pandemic. One change gave states extra federal funding to keep customers enrolled, even if they might no longer be eligible. This "continuous coverage" made sure customers would not lose coverage during the pandemic unless they moved out of state, requested cancellation, or passed away. Now, Congress has set an end to continuous coverage.

When will continuous coverage end?

A better question is: When will Illinois resume regular eligibility checks?

The first time anyone with Medicaid will get a renewal notice in the mail will be the start of May 2023. But that will only be for people whose coverage is due for renewal by June 1.

It is important to know that everyone’s renewal date is different. Everybody else will keep their coverage until it is their redetermination month. There will be no “coverage cliff.”
The next people to get renewal mail will be people due July 1; they will get their notice the first week of June. And so on throughout the year. Everyone will get their notice in the mail a month before their due date.

The best thing customers can do is be ready to renew.

1.    Click Manage My Case at abe.illinois.gov to set up your online account

2.    Verify your address is correct to make sure you get our mail (the address we have on file for you is in the ‘Contact Us’ tab)

3.    Look up your due date so you know when to expect our letter (their due date is in your ‘Benefit Details’ tab)

What will happen when continuous coverage ends?

We must resume regular eligibility verifications, also known as renewals or redeterminations.

We will mail renewal forms to the head of household and authorized representative on the case if there is one. If we have enough information about a customer to automatically renew them, their renewal form will tell them what information we used to determine their eligibility and ask for any corrections. If we need more information, the form will ask for more information. Medicaid customers will then have to submit their renewal, and we will check their eligibility. This process is called "redetermination," which will be the term used on the forms.

People will get their renewal forms one month before they are due, and all renewals are due by the first day of the following month. For example, if a person's renewal is due by June, they will get their renewal form the first week of May and must return it by June 1. People whose renewals are due in July will get a letter the first week of June and must return them by July 1, and so on.

If someone doesn't qualify anymore, they may lose coverage a month after their renewal due date. So, for people whose renewal date is June 1, they may lose coverage as early as July 1.

A 30-day grace period is given when a customer does not submit their renewal on time. This is a new flexibility offered by CMS and HFS implemented this strategy beginning in June 2023, with CMS approval. This flexibility has been put in place to help minimize the loss of medical coverage for eligible customers during the redetermination process. The new flexibility permits the delay of case cancellations for one month (approx. 30 days) for customers who did not return their redetermination by their due date. We are now providing more time for customers to return their redeterminations so that our state caseworker processing staff can review and make accurate determinations. During the 30 day grace period the state and Managed Care Organizations will continue outreach efforts, and a renewal reminder letter will be sent to the customer.

Here is the timeline below. This pattern continues for each month of the year, and it includes a 30-day grace period for customers that need more time to submit their Redeterminations:

Updated 08/03/2023 

Here is the timeline below. This pattern continues for each month of the year, and it includes a 30-day grace period for customers that need more time to submit their Redeterminations:

How will the end of continuous coverage affect me?

When it is time for you to renew, you will get a letter from us at the address we have for you. If we have enough current information about you to decide if you still qualify, we might be able to automatically renew your coverage. If we need information, you must submit your renewal by the due date on your form.

You can submit online by clicking Manage My Case at abe.illinois.gov, mail your form according to the letter, or call 1-800-843-6154. Online is best.

How do I find my renewal date?

You can find your renewal date by clicking Manage My Case at abe.illinois.gov. Your due date is in your 'Benefit Details' tab.

Your renewal will be available about 1 month before your renewal is due. If it is time to renew your benefits, you will see a 'Renew My Benefits' button on your 'Case Summary' page.

It is important to know that everybody's due date is different. There will be no "coverage cliff" where everybody needs to renew all at once. We renew people all year.

Can I check my Medicaid renewal date by phone like my SNAP card benefits?

Yes, you can check your renewal date by phone by calling the HFS Automated Voice Response System (AVRS) at 1-855-828-4995. This option is available 24 hours a day and it is available in English and Spanish One important note is that you will need to know your RIN (Recipient Identification Number).

This number can be found on your HFS issued medical card or on your Managed Care Plan insurance card. If you don’t know your RIN (Recipient Identification Number) you can be assisted by a Health Benefits Hotline Representative during normal business hours which are Monday – Friday, 8:00 AM – 4:30 PM.

If I don’t speak English or Spanish, how can I complete my renewal over the phone in my preferred language?

When calling the call center at 1-800-843-6154, we will access a live interpreter to assist you with translation.

What if I am no longer eligible for Medicaid?

If you are no longer eligible for Illinois Medicaid, you will receive a letter that tells you:

• When your coverage ends
• How to appeal our decision
• Options for purchasing other health care coverage, such as through your employer or getcoveredillinois.gov, the official Affordable Care Act Health Insurance Marketplace for the state of Illinois, which offers free enrollment assistance and can help you find out if you may qualify for financial help. Many people find plans for $10 or less per month after tax credits.
  

If you are no longer eligible for Medicaid, it is important to quickly get other health insurance. You usually have 60 days to enroll in a new plan. This is called a "special enrollment period." Ask your job about health insurance or visit the official Affordable Care Act marketplace for Illinois at GetCoveredIllinois.gov. You can get free help singing up for a plan that meets your needs. Most people find a plan for $10 or less per month after tax credits.

When is the ABE Customer call center open?

Until April 30^th the call center hours are Monday - Friday, 8:30 AM – 4:30 PM except for state holidays. Beginning May 1, 2023, the hours are Monday – Friday, 8:00 AM – 6:30 PM except for state holidays.

What if I have other questions?

Log in and click Manage My Case at abe.illinois.gov, where you can send us a message, or call us at 1-800-843-6154.

How will the exchange of needed verifications work when I complete my redetermination by phone?

Call center teams will enter information you provide over the phone into the state’s Integrated Eligibility System, which is the system a state caseworker uses to process your case. If further information or verifications are needed, a Verification Check List (VCL) will be generated and mailed to you. This form will contain a list of what is needed, and it will also provide a date for when you need to submit the other verifications requested. You will have 10 days to submit the required verifications, but if you need more time, please call 1-800-843-6154.

Also, it is your responsibility to gather all the appropriate verifications and submit them by the due date listed on the VCL (Verification Check List). Failure to do so can result in the cancellation of your case. 

How do I prove my identity when creating a my Manage My Case account?

You must complete ID proofing to use Manage My Case. You can use a valid state ID or non-expired driver’s license, including a temporary visitor’s driver’s license.
 

1. If you do not have a valid state ID or driver’s license, you will need to go through Experian identity proofing. You will have to answer randomly generated questions based on your credit history. For example, you may be asked about previous addresses, property, or vehicles you’ve owned, or schools you’ve attended.
2. If you can’t use a state ID or driver’s license and Experian identity proofing fails, you may submit a state identity proofing request form, available in English (PDF) and Spanish (PDF).

For more information, check out our quick guide to setting up a Manage My Case account.           (English) (PDF) (Spanish) (PDF)

What do I need to do to ensure I will receive my renewal letter?

Please, update your address with Illinois Medicaid today!

Medicaid pays for your healthcare, like visits to your doctor and your medicine. By updating your address, you can avoid surprises and get updates about your insurance.

You can go online to update your address at medicaid.illinois.gov or call 877-805-5312 for free from 7:45am – 4:30pm. If you use a TTY, call 1-877-204-1012.

How can I get a duplicate pre-populated renewal (redetermination) form if I don’t have a Manage My Case account and need to complete it quickly

If your redetermination form is lost, the best way to complete your renewal is to create a Manage My Case account, log into your existing Manage My Case account or by calling 1-800-843-6154.

If necessary, you can also obtain another renewal form by connecting with our call center. If calling is not an option, you can visit your local Family Community Resource Center (FCRC). To find your local FCRC visit, dhs.illinois.gov/officelocator.

What is an Ex Parte Redetermination and how do I know if I will be receiving one?

An ex parte renewal is a redetermination of eligibility based on reliable information contained in the customer’s case including information accessed through electronic data sources. A key distinction in defining ex parte renewals is that it happens “without” customer involvement. All medical cases are reviewed to determine ex-parte eligibility.

An ex-parte redetermination will be mailed to you when your rede is due and will inform you that your benefits will continue. The form includes the income information used to make the determination. If any of the information used to make the determination is not accurate, you must report the change(s) and the new information will be used to determine your ongoing medical benefits.

What happens if I miss my due date?

We are doing everything we can to make sure you do not miss your due date. HFS has implemented a new flexibility to minimize the loss of medical coverage for all customers during the unwinding redetermination process. The new flexibility permits us to delay the cancelling of cases for one month (approx. 30 days) for customers who did not return their redetermination by their due date. 

Also, during the one-month grace period, additional efforts are being made to encourage you to return your Medicaid Redetermination - Form B. If you miss your due date, we will issue a 643RNW Courtesy Renewal Form – Follow Up Letter. This letter: 

• Will be generated by the 20th of each month when a customer’s redetermination has not been received by the mid-month cut-off date of the month in which their redetermination is due. 

• Will remind customers to return their completed Form B redetermination no later than mid-month of their new, extended due date per the new flexibility. 

• Will remind customers of the ways in which they can renew their medical coverage.  

• Will provide the customer an opportunity to indicate a reason, if they do not wish to continue receiving medical coverage 

It is important to know that every customer’s redetermination date is different.  Redetermination notices will arrive at the start of each month and are due by the date listed on the Redetermination Form. 

If you miss the due dates listed above, we will send you a letter telling you the date you will lose your Medicaid coverage. However, there is a chance that we can still renew your coverage if you submit your renewal within 90 days of your first day of coverage loss. We will review your case on an individual basis.

If you are reinstated, your Medicaid coverage will be retroactive back to your original renewal due date. That means we will pay for healthcare costs you had between your original due date and when we reinstated your coverage. We highly recommend you submit your Redetermination form even if you miss your due date.

If you are more than 90 days late, you are required to reapply completely with a new application. 

If I miss my renewal date but I am still within the timeframe to be reinstated and I complete my renewal, will I automatically be re-enrolled with the Managed Care Plan I had prior, or will I have to select a new plan upon reinstatement?

It depends on when your medical reinstatement is processed. Enrollment in the same Managed Care Plan can only happen if your reinstatement of coverage is posted to the state’s Medicaid Management Information System (MMIS) by the 90^th day after you lose coverage.

Please be aware that it can take up to two days after your reinstatement is processed for this information to be transferred to the state’s MMIS. If the redetermination is processed after the 90-day reinstatement period, then you will have to go through the managed care plan selection process. 

How will the end of continuous coverage impact healthcare providers?

We will need your help to make sure people who use Medicaid stay connected to coverage. Tell your customers to keep their address and contact information up to date with the state of Illinois by visiting abe.illinois.gov.

Please set up a system to help customers at multiple points, like during check-in, appointments, and check-out, as well as in appointment reminders. Please ask them to update their address with us and check for our mail a month before their due date.

If you are enrolled as an Application Agent and can assist people with renewals, please be ready to help Medicaid customers connect to coverage. If you are a Federally Qualified Health Center that gets funding for navigators, please assist people who are no longer eligible for Medicaid check with their employer for coverage or sign up on getcoveredillinois.gov.

How do I check my patient's eligibility and renewal date?

You can find their eligibility and renewal date in MEDI or call the patient's Managed Care organization.

To find a patient's renewal date in MEDI:

• Log in to MEDI at medi.hfs.illinois.gov.
• After logging in you will arrive at the MEDI Landing page. Choose the link for Internet Electronic Claims System (IEC).
• When the IEC page opens you will see a left Navigation bar; choose the second option on Left Navigation titled Eligibility Inquiry.
• From the "Recipient Eligibility Verification" screen you can enter a combination of the listed required fields to search for an individual.
• All fields DO NOT need to be filled out to search. Use the dropdown to select the prepopulated "Provider ID" and "NPI" fields.
• Using the begin date entered and the recipient information, the system will search for an individual match. If a match is found the screen will populate with case information including Medicaid eligibility for the date specified, the Recipient Identification Number and the Renewal Due Date(rede). You can also determine the IES Case ID by editing the Case ID listed here by removing the first 5 digits.

Will this change the provider enrollment process?

No. The provider enrollment process will stay the same. If you have questions about provider enrollment, please call 877-782-5565 and select option 1.

Are HFS Application Agents able to run lists of customers through MEDI (Medical Electronic Data Interchange) to see who is due for a renewal?

If you are registered and authorized in MEDI for the Internet Electronic Claims (IEC) and the Recipient Eligibility Verification (REVS) web applications, you can check recipient eligibility two ways:

1.       A single inquiry can be done in real time using the REVS Direct Date Entry (DDE) web application.

2.       Batch inquiries using the HIPAA 270/271 transactions can be done using the IEC web application. 

Entities that have joined the Electronic Data Exchange (EDX) program can check eligibility in real time and batch modes using the CAQHCORE Safe Harbor web service.  They can also check eligibility using FTPS in a batch mode.  The HIPAA 270/271 eligibility transactions are used in both options. 

If you wish to join the EDX program, you should email HFS.EDITradingPartner@illinois.gov and request a Trading Partner Agreement and an Application for the EDX program.  

Does the MEDI (Medical Electronic Data Interchange) system indicate which form a person will receive?

Yes, though HFS Application Agents should be careful of timing. Form A and From B in MEDI will not be current until the month that the notices will be sent out. Prior to that, MEDI will show the customer’s redetermination month, but will not show which form they are set to receive

Some Medicaid customers state they have received a rede form already - is that true?

Yes, HFS has been sending ex-parte redeterminations throughout the pandemic. Customers may have received renewal forms for other benefits like SNAP or Cash.

Medical redetermination forms that require a customer response to continue coverage have not been sent. The first mailing will occur May 1, 2023, for customers whose certification period ends June 30, 2023.

Is there a standard PDF renewal form that hospitals and FQHCs could have in the event a customer loses theirs?

No, there is not a PDF renewal form that can be provided to hospitals, FQHCs or other provider types. Customers who lose their renewal form should complete their renewal by creating a Manage My Case account, logging into an existing Manage My Case account or by requesting a new form from the customer call center which can be reached at 1–800-843-6154.

What will happen to the extra federal money the state received during continuous coverage?

The enhanced federal match of 6.2 percentage points for the continuous coverage continues through March 2023, and will phase down to:

• 5 percentage points April – June 2023
• 2.5 percentage points July – September 2023 and
• 1.5 percentage points October – December 2023

How many cases does HFS expect to be up for renewal each month?

The number of cases up for renewal varies from month to month but is typically between 165,000-280,000 per month.

How many cases can be renewed using the Ex Parte process?

We are currently averaging 50% of cases that can renew via the Ex Parte process. This means that for 50% of cases customers do not need to take action. As a result of expanding our systems and capabilities we are now able to run more electronic clearances on customers thus contributing to an increase in our Ex Parte percentage rates.

How many people will lose their Medicaid coverage?

Medicaid enrollment has swelled during continuous coverage, partially because people who normally come on and off coverage have all stayed continuously covered, and partially because of the economic and health-related consequences of the Covid-19 pandemic. We now have roughly 3.9 million people in Illinois enrolled in Medicaid, compared to roughly 2.9 million before the pandemic.
 

The truth is nobody knows for sure how many people will lose Medicaid benefits, but we are taking steps to minimize loss as much as possible. A federal analysis estimated about 17% of people will lose Medicaid insurance based on historical patterns. If the federal estimate holds for our state, then around 700,000 will lose Medicaid coverage. Our estimate is more optimistic in that we believe we will be able to help eligible customers keep their benefits. We think about 32,000 people per month will lose Medicaid coverage, or 384,000 after the full unwinding period.

To be clear: Becoming ineligible for Medicaid coverage doesn't mean you can't get health insurance; it means you need to use other sources of coverage available to you. Most people stop qualifying for Medicaid when they earn too much money. People who no longer qualify for Medicaid should ask their employer about a work-based health plan, or visit getcoveredillinois.gov to shop for quality, affordable coverage provided under the Affordable Care Act. Get Covered Illinois offers free enrollment assistance and can help people find out if they qualify for financial help. Many people find plans for $10 or less per month after tax credits.

We are committed to ensuring that everyone who is eligible maintains their coverage, and that those who are not eligible are given information regarding alternative health insurance options. We strongly urge Medicaid customers to get ready to renew by clicking Manage My Case at abe.illinois.gov to verify their address and find their due date, and then watching their mail so they can complete and submit their renewal materials as soon as they receive them to ensure their coverage continues without disruption. And of course, if someone's situation changes after they are determined ineligible, we encourage them to reapply.

What is HFS doing to engage with Medicaid customers?

We are planning a state-wide, omni-channel, paid, earned, and owned media communications campaign to help our Medicaid customers get ready to renew their Medicaid. The details of this plan will be available soon.

In the meantime, we are asking all Medicaid customers and anyone who works with them to help make sure they are to renew. Please use our messaging toolkit to help in this effort.

Please think about practical ways you can incorporate the renewal messaging and toolkit assets into your interactions with Medicaid customers.

How can I get more information?

You can email hfs.communications@illinois.gov for questions.

How will Managed Care Organizations (MCOs) partner with HFS during the unwinding?

MCOs often have more frequent communication with customers and will supplement HFS efforts to ensure Medicaid customers get important information during the unwinding.

MCOs will provide HFS with more current contact information, and HFS will use that information to update addresses and emails in the eligibility system.

MCOs will help inform customers of their redetermination date, conduct targeted outreach to Medicaid customers due for renewal, and help customers who lose coverage either re-enroll in Medicaid or transition to low-cost marketplace coverage.