Provider Notice issued 04/29/04

Notice of New Temporary KidCare Medical Benefits

Beginning May 3, 2004, the department will begin streamlining enrollment for children by taking advantage of a presumptive eligibility strategy established in federal law and used successfully by other states.  To implement presumptive eligibility (PE), a new Notice of Temporary KidCare Medical Benefits will be issued to persons under the age of 19 who are deemed presumptively eligible for medical benefits administered by the department.  The temporary eligibility notice will be issued on an 8½” x 11” sheet of paper rather than a MediPlan Card.  A sample notice is attached (Attachment 1).

Persons with the temporary coverage are eligible for all medical services covered under the Medical Assistance Programs.  Participant co-payments should not be assessed during the temporary coverage period.  Providers will be reimbursed at the regular medical assistance rates with no deductions for co-payments.

If a child is without private or state-funded health insurance, an application for KidCare can be made on the same day as service is provided.  The new PE strategy will allow providers to give services to such children with reasonable assurance that they will be paid, if an application is faxed to the Central KidCare Unit on the same date and the following requirements are met: the family meets income guidelines; the child has not received PE coverage within one of the last 12 months, and; the child meets the citizenship/immigration requirements.  Refer to the Temporary KidCare Medical Benefits Fact Sheet (Attachment 2) for additional information on PE coverage requirements.  In addition, providers will be able to immediately refer children to a specialist, if necessary.

A chart is attached (Attachment 3) showing the applicable income ranges for a family (children and parents) in order for the child(ren) to qualify for KidCare.  Providers can assist families with the application (Form 2378 KC) at the point of service or ask families to fill out the application while waiting.  For providers not enrolled as KidCare Application Agents (KCAA) the application may be faxed to 217-785-1647.  The application can be found online at http://secure.myhfs.illinois.gov/ 

The temporary coverage through PE may start and stop in the middle of a month when regular medical assistance eligibility is approved or denied.  It is the responsibility of the provider to verify a patient’s eligibility prior to providing services.  Eligibility can be verified by using any of the following sources:

• The Medical Electronic Data Interchange (MEDI) Internet site at <http://www.myhfs.illinois.gov/>;

• Your REV vendor; or

• The Automated Voice Response System (AVRS) by calling 1-800-842-1461.

Questions regarding this notice should be directed to the department’s Provider Hotline at 1-800-842-1461.  Thank you for your assistance in making this new coverage program a success.

Anne Marie Murphy, Ph.D.

Administrator

Division of Medical Programs