Provider Notice Issued 06/28/2022

Date:    June 28, 2022 

To:       All Medical Assistance Program Providers 

Re:      Health Benefit Coverage for Immigrant Adults Aged 42 through 64 Years and Continued Emergency Medical Coverage for Persons Not Meeting Immigration Status

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This notice informs providers of new medical coverage benefits for non-citizens aged 42 through 64 years who do not meet immigration status for Medicaid coverage. It also reminds providers of existing coverage of emergency medical services for persons not meeting immigration status.  

Health Benefits for Immigrant Adults Aged 42-64 years

Public Act 102-0016 created the Health Benefits for Immigrant Adults program for immigrant adults aged 55-64 years who are ineligible for Medicaid due to their immigration status. Public Act 102-1037 further lowered the eligibility age for this program to 42-64 years. This program is state funded only, with no federal matching funds. Covered services align with the Health Benefits for Immigrant Seniors program for seniors aged 65 years and older, which was first identified in the provider notice dated December 11, 2020. Current limitations of note for both the adult and seniors' programs: 

• Home and Community Based Waiver services are not covered services at this time.
• Transplant services are limited to kidney transplants and inpatient bone marrow transplants.
• Long Term Care facility services are not covered.
• Hospice services are covered, but if the customer becomes a resident of a nursing facility, the Department of Healthcare and Family Services (HFS) will not cover the nursing facility room and board charges. A hospice provider may bill only for its hospice services and not the related nursing facility room and board charges. Note: Respite care, which is for the benefit of the hospice patient's caregiver and allows the patient to stay in an applicable hospital or nursing facility for up to five days, is still billable by the hospice provider. 
   
  

Many immigrant adults aged 55-64 years are already enrolled and receiving benefits through the new Health Benefits for Immigrant Adults program. Customers aged 42-54 years may begin applying for benefits effective July 1, 2022. Customers may receive backdated eligibility for up to three months before the month of application, if eligible in each month. Customers are covered under the Medicaid fee-for-service (FFS) program and there are no copayments on the medical services.   

Special Note for Pharmacy Services
While the Pharmacy Benefit Management System (PBMS) is being programmed to accept claims for this group, a manual override must be secured to allow claims to be processed electronically. This override can be requested by calling 877-782-5565 and following the prompts to billing consultants in the Bureau of Professional and Ancillary Services' Pharmacy Unit. 

Emergency Medical Coverage for Non-citizens Ineligible for Medicaid due to Immigration Status

Individuals aged 19 years and older who are ineligible for Medicaid due to their immigration status continue to be eligible for federally matched emergency medical coverage. The Department strongly encourages providers to continue to use the emergency medical process in place for individuals ineligible for Medicaid due to their immigration status, including those enrolled in Health Benefits for Immigrant Seniors and Health Benefits for Immigrant Adults. Since federal matching funds are available for services covered under the Emergency Medical Coverage for Non-Citizens, the financial resources for the state-funded programs mentioned above can be better utilized to cover ongoing, non-emergency medical services.  

Applying for Coverage

Illinois residents can apply for these medical programs in one of the following ways:  1) online at www.ABE.Illinois.gov ; 2) contacting a Community Service Agency (help is available in 59 languages); 3) calling 800-843-6154; or 4) mailing in a Paper Application.   

Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565.

Kelly Cunningham, Administrator

Division of Medical Programs