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Elizabeth M. Whitehorn, Director

Provider Notice issued 12/27/13

Eligibility Change in the State Renal Program Effective January 1, 2014

To:​ Enrolled Hospitals and Renal Dialysis Facilities​
Date:​ December 27, 2013​
Re:​ Eligibility Change in the State Renal Program Effective January 1, 2014​

The purpose of this notice is to remind providers of a state law change (Public Act 98-0104) involving patient eligibility for the State Renal Program effective January 1, 2014.

The Illinois State Renal Program was originally implemented to provide assistance to Illinois residents who had been diagnosed with chronic renal disease and did not have insurance or had costs that insurance did not cover, but did not qualify for Medicaid. As a result of the Affordable Care Act (ACA), a patient's primary insurance may begin to cover the costs currently covered through the State Renal Program.

In accordance with Public Act 98-0104, patients must meet their obligations under the ACA and may be required to obtain and provide proof of health coverage to the department. Payment of a tax penalty for not obtaining insurance does not meet the requirement. The department has notified current participants by letter regarding these upcoming changes.

If a patient has Medicare as their primary insurance, the State Renal Program will still remain the secondary payer. If a patient does not have health insurance or their primary insurance does not cover the costs currently being covered through the State Renal Program, individuals may be eligible for assistance through one of the options below.

  1. Expanded Medicaid for Adults – Adults between 19 - 64 years old with limited income may now be eligible for Medicaid. Medicaid provides free or low-cost health coverage and covers a comprehensive set of health benefits including renal dialysis and certain covered injectable drugs associated with dialysis treatment.

  2. Health Insurance Marketplace - The Health Insurance Marketplace is a website where health insurance companies sell health coverage to uninsured people who do not get insurance at work and do not qualify for Medicaid. The first open enrollment period is October 1, 2013 – March 31, 2014.

To get a list of community assisters who can help with the Health Insurance Marketplace, please call 1-800-318-2596 (TTY: 1-855-889-4325) or log on to HealthCare.gov.

Any questions regarding this notice may be directed to the Bureau of Hospital and Provider Services at 1-877-782-5565 extension 7021.

Theresa A. Eagleson, Administrator

Division of Medical Programs