Provider Notice issued 10/24/06

All Kids and Veterans Care Programs

All Kids

Effective with dates of service on or after July 1, 2006, HFS’s medical coverage for children was expanded under the provisions of Governor Blagojevich’s new All Kids program. As part of this expansion, Medicaid and KidCare coverage of children has been renamed All Kids as well.

All Kids health insurance provides affordable and comprehensive health insurance to Illinois children, regardless of family income, immigration status or health condition. Participants in the All Kids expansion will receive an identification card printed on canary yellow paper with the All Kids logo printed at the top . Additional information regarding the All Kids program can be found at: http://www.allkidscovered.com/

Participants in the All Kids expansion will be eligible to receive behavioral health services through the Screening, Assessment and Support Services (SASS) program. Note that the current exclusions—children enrolled in All Kids Rebate or with Medicaid managed care organization—continue. SASS and SASS-like services for those children are the responsibility of their health plans.

Veterans Care

Effective September 1, 2006, medical coverage is available to veterans across Illinois. Veterans Careis a landmark program where the State of Illinois will offer access to affordable, comprehensive healthcare. Participants in Veterans Care will receive an HFS MediPlan Card with “Veterans Care” printed on the front of the card and the responsible local office code will be “196”. For more information on Veterans Care, please visit: http://www.illinoisveteranscare.com/

CMH providers will send claims for services rendered to participants in the Veterans Care program to HFS in the same manner as the SASS claims.

Benefit Package

The statute and regulations that established All Kids and Veterans Care provide that the benefit package for the expanded populations “be identical to the benefits provided for participants of the State's approved plan under Title XIX of the Social Security Act,” with the exception that coverage will not be available for non-emergency transportation or non-plan services available only through a waiver program. In addition, Veteran’s Care participants will not be eligible for Long Term Care Services, including Supportive Living Facilities.

All Kids participants receiving behavioral health services through the SASS program will receive non-emergency transportation for medically necessary services during the SASS eligibility period.

Most of the participants in the All Kids expansion population and Veterans Care were previously eligible for community mental health services as “non-Medicaid” patients, although they may have not accessed the services. The principal changes resulting from the All Kids expansion and Veterans Care will be (a) how these program participants are classified and accounted for in the State data processing systems and (b) the cost-sharing requirements that are applicable to these participants.

Cost Sharing Requirements

The expanded coverage under All Kids is named All Kids Premium Levels 2 through 8 to correspond with seven eligibility income groups. Cost sharing, for children covered under the expansion to higher income levels, includes co-payment amounts that vary by family income. Please note that copayment requirements for children previously covered under All Kids (KidCare) have not changed.

Under All Kids Premium Levels 2 through 8 and Veterans Care, a co-payment will be assessed on certain fee-for-service visits to a physician, chiropractor, podiatrist, optometrists, nurse practitioner or hospital, all billable encounters (medical and behavioral health) at a FQHC, ERC or RHC, hospital inpatient, emergency room and outpatient services. HFS has updated the cost sharing information in the Chapter 100 Handbook. Appendix 13 contains the new cost sharing information for the All Kids expansion and Appendix 14 contains co-payment information for the Veterans Care program. The Chapter 100, General Policy and Procedures Handbook is available on HFS’s Web site at: http://www.hfs.illinois.gov/handbooks/

Questions regarding this notice may be directed to the Bureau of Comprehensive Health Services at 1-877-782-5565.

Anne Marie Murphy, Ph.D.

Administrator

Division of Medical Programs