All Kids Application Agent Alert # 1
For October 2007 Manual
FAMILYCARE EXPANSION
Governor Blagojevich has expanded Illinois' FamilyCare program. It is now open to families making up to 400% of the Federal Poverty Level (FPL). FamilyCare offers healthcare coverage to parents living with their children 18 years old or younger. FamilyCare also covers relatives who are caring for children in place of their parents.
Parents and caretaker relatives must be U.S. citizens or meet immigration requirements and must have lived in the U.S. for a minimum of five years.
- Effective December 1, 2007, the income limit for the program was raised from 185% FPL to 400% FPL making 147,000 more parents eligible for healthcare coverage. (See income guidelines chart)
- That's an annual income of $82,600 for a family of four (up from $38,202), and even more for larger families.
- Parents with income over 200% FPL must be uninsured for a minimum of 12 months in order to qualify or meet an exception, such as:
- The individual has been without health insurance for at least 12 months prior to the date of application unless the individual is a pregnant woman, in which case the individual was without health insurance when her pregnancy was medically confirmed;
- The individual lost employer-sponsored health insurance when their job or their spouse's job ended;
- The individual has exhausted the lifetime benefit limit of his or her health insurance;
- The individual is currently on COBRA;
- The individual was disenrolled from FamilyCare or All Kids within one year prior to the date of application unless the individual has state-sponsored health insurance; or
- The individual aged out of coverage under a parent's health insurance.
- Individuals must not have State of Illinois health insurance or state-sponsored health insurance from another state.
- The individual must not owe any unpaid All Kids or FamilyCare Premium debts or Rebate overpayments.
How much will it cost for Families?
- Parents between 150% FPL and 200% FPL pay the same premium parents pay now for their children in All Kids Premium Level 1 – $15 to $40 per month depending on how many family members are covered. They have lower co-payments.
- Parents between 200% FPL – 400% FPL pay double the premium they pay for their children. They have lower co-payments.
- 200% - 300% FPL: $Â 80 per adult / month.
- 300% - 400% FPL: $140 per adult / month.
| |
Premium Level 1
150 – 200% FPL |
Premium Level 2
200 – 300% FPL |
Premium Level 3
300 – 400% FPL |
Monthly Premium |
$15 for 1
$25 for 2
$30 for 3
$35 for 4
$40 for 5 or more |
$80 per adult |
$140 per adult |
Each Visit to a Doctor |
$2 |
$2 |
$2 |
Each Name Brand Prescription |
$3 |
$3 |
$3 |
Generic Prescription |
$0 |
$0 |
$0 |
Each Emergency Room Visit |
$0 |
$0 |
$0 |
Outpatient Services |
$2 |
$2 |
$2 |
Inpatient Hospital Admission |
Up to $3 per day |
Up to $3 per day |
Up to $3 per day |
Labs and Radiology |
$0 |
$0 |
$0 |
Prior Coverage |
Only available the first time any adult (or child) is found eligible and must be requested within the first six months of eligibility. * |
N/A |
N/A |
*Prior coverage is available to adults with income above 185% FPL no earlier than 11/7/07. Prior coverage is only authorized the first time an adult is eligible for FamilyCare Share or FamilyCare Premium Level 1 and must be requested on a 243KC.
Families currently pay $40 - $70 per child in these ranges.
Local FCRC offices will enroll eligible parents in FamilyCare Premium Level 1 at application and renewal.
Local FCRC offices will enroll adults in spenddown who may qualify for FamilyCare Premium Levels 2 and 3 and transfer files to the Central All Kids Processing Unit. The Central All Kids Unit will decide if the adults qualify for FamilyCare Premium Level 2 or 3. Families will be notified once a decision on eligibility for FamilyCare Premium Level 2 or 3 has been made.
Any parent or caretaker relative approved for FamilyCare Premium Level 2 or 3 who doesn't want to pay the required monthly premium must contact the All Kids Customer Service Line immediately at 1-877-805-5312 to be removed from the case to avoid the 3-month sanction.
In addition, adults enrolled in Premium Levels 2 or 3 will get a separate white medical card. Their children will continue to get yellow medical cards.
Families enrolled in FamilyCare Premium Levels 1-3 may call the toll-free All Kids Customer Service line at 1-877-805-5312, with any questions about their coverage.
When parents want to apply for coverage and their children are ALREADY enrolled in All Kids:
Please complete form HFS 243C, "Request For Medical Benefits For Another Family Member(s)". Each question must be answered completely.
For information that requires proof, use the same guidelines currently used for completing the All Kids and Family Care 2378MC application. Since this form does not accompany a completed 2378MC application, it must be signed and dated by the applicant.
Submit completed forms by fax to 217-557-9092, or mail to:
All Kids Central Processing Unit
PO Box 19122
Springfield, IL 62794.
AKAAs can make copies of the attached form or order copies of the HFS 243C "Request For Medical Benefits For Another Family Member(s)" from the warehouse by using the HFS 1517 or ordering online at:
http://www.allkids.com/akaa/allkidsforms.html
For more information on FamilyCare, visit: http://www.familycareillinois.com/
All Kids Hotline 1-866-ALL-KIDS (1-866-255-5437)
TTY: 1-877-204-1012
