Children for whom the Department has a legal responsibility (with the exception of children in the home of their natural parents and children in the Refugee Assistance program) and children adopted since June 17, 1980 with a monthly adoption subsidy payment are eligible for services through the Department of Public Aid's Medical Assistance Program.
Since it is the objective of both Departments (DCFS and DPA) to promote and maintain the normal growth and development, health and well-being of each
child placed in care, the child's caretaker should seek services from those medical providers, practitioners and related medical resources which meet the quality and standards of both Departments.
// For children who have hearing impairments or who are limited/non-English speaking, interpreters shall be provided as necessary in order to facilitate communication with health care professionals.
Required Medical Records. Because up-to-date medical records of children in placement are important, the worker is responsible for assuring that there is proper recording in the child's case record of immunizations and/or boosters, illnesses, allergies, special food requirements, dental examinations and other pertinent medical information. Forms CFS 600, Certificate of Child Health Examination and CFS 60l, Dental Examination Record are to be used for such recording. Both forms should be given to the caretaker who shall ensure that such information is recorded. If a new placement occurs, both forms are to move with the child. Photocopies of both forms must be placed in the child's case record at least on an annual basis. Form CFS 404, New Born Infant Record shall be used for newborn medical data.
Division of Specialized Care for Children Staff should fully utilize the services available through the University of Illinois' Division of Specialized Care for Children for appropriate youth for whom DCFS is legally and financially responsible (See Appendix C of this Subpart).
Healthy Kids Program (Formerly Medichek). Preventative or "well child" physical examinations should be arranged for every child entering placement. Following the first visit, physical examinations should be arranged according to the following schedules:
Birth to 1 mo. 2 yrs. to 4 yrs
1 mo. to 3 mos. 4 yrs. to 6 yrs.
5 mos. to 8 mos. 6 yrs. to 9 yrs.
8 mos. to 12 mos. 9 yrs. to 12 yrs.
12 mos. to 18 mos. 12 yrs. to 16 yrs.
18 mos. to 2 yrs. 16 yrs. to 21 yrs.
A. Medical Availability |
Medical services are available to youth who reside at or who are placed in any of the following living arrangements:
o CUS College/University Scholarship-DCFS Scholarship only
o DET Detention Facility/Jail
o FHA Foster Home Adoptive
o FHB Foster Home Boarding--DCFS
o FHI Foster Home Indian--Licensed or approved by child's tribe.
o FHP Foster Home Boarding--Private Agency
o FHS Foster Home Specialized
o GRH Group Home
o HHF Hospital/Health Facility
o HMR Home of Relative--Not licensed or approved.
o HMP Home of Parent--With service code 0301*
o HRA Home of Relative--Approved
o HRL Home of Relative--Licensed
o ICF Institution--DCFS
o IDC Institution--Department of Corrections
o ILO Independent Living Only
o IMH Institution--Department of Mental Health
o IPA Institution--Private Child Care Facility
o NCF Nursing Care Facility
o OTH Other
o RNY Runaway
* Children adopted after June 17, 1980 with an ongoing adoption subsidy payment are eligible for medical services through DPA's Medicaid Program. When a child in this category has a living arrangement code of HMP in CYCIS, the service code must be shown as 0301.
There are two (2) methods by which children listed in the above categories may receive a medicaid card.
1) The child may already have a current DPA Medicaid card under a category 98 (AFDC/FC) case. The card may have been previously issued through the regular application process - completion and data entry of the Eligibility forms (CFS 1411, 1412 and 1413) and subsequent determination by the DCFS Eligibility Unit. Refer to Procedures 351, Appendix A for more detailed information regarding AFDC/FC and MANG eligibility.
2) The child may be issued a DPA 469D, Temporary Medical Eligibility Card, which will eventually result in the child's receipt of the "regular green card." The DPA 469D is to be issued by designated DCFS staff when:
- the child has a clear medical need (includes children taken into temporary protective custody),
- placement in a paid or unpaid living arrangement is anticipated,
- an adoptive parent who is receiving an ongoing subsidy requests a card, or
- the child's regular Medicaid card is not available and the child requires medical care prior to receipt of the next monthly card.
When a DPA 469D has been issued, a CYCIS case must be opened in accordance with Rules/Procedures 304, Access to and Eligibility for Child Welfare Services, Section 304.6 and Appendix A, and Administrative Procedure #5, Child Welfare Case Record Organization and Uniform Case Recording. NOTE: When a DPA 469D has been
issued or a Regular Medicaid card requested for an adoptive case (with subsidy payment), the child's preadoptive case must have been closed, and the new case information and a new legal status of "NO" entered into CYCIS. However, when guardianship has not been terminated by the Juvenile Court, a CFS 906 (Placement/ Payment Authorization) with a final living arrangement of HAP must be submitted.
The DPA 469D shall be issued as an initial card when it is the Department's first involvement with a child or when the child's previously active Medicaid case has been closed.
The DPA 469D information from the initial card must be telephoned to the Central Office Eligibility Unit via the 800-228-6533 "Green line." The telephone call should be made by the Field Office/Site designee no later than the next business day after the DPA 469D has been issued. Once the initial card information has been entered into DPA's system, any Regular Green Card (DPA 469) issued after the 15th of the month will cover the remaining period of the current month and the entire period of the next month. Therefore, the first DPA Medicaid card may cover up to two (2) months.
The DPA 469D shall be completed and issued as a replacement card when there is already an open case, and the child's Temporary or Regular Medicaid Card (DPA 469) is not available - misplaced, destroyed, stolen, etc., and the child's address has not changed. The DPA 469D information for a replacement card is not to be telephoned to the Eligibility Unit unless the child's Temporary Medical Card will expire before the receipt of the next regularly scheduled Medicaid card. When a replacement card is issued on the 17th of the month or later, it is not necessary to call the Green Line. However, when a replacement card is issued before the 17th of the month, designated callers shall telephone the information to the 800 228-6533 number to have the regular Medicaid card issued for the remainder of the month.
Medical Assistance Category Definitions. The following category identifiers have been established to designate which Department will assume responsibility for medical bills for youth in need of medical care who have no resources of their own.
Category 98 (Group 211/01) IV-E Foster Care/Judicial |
Children for whom DCFS has court-ordered legal responsibility who are placed in licensed or approved foster homes, institutions or group homes and who meet AFDC requirements. |
Category 98 (Group 211/11) MANG Foster Care/Judicial |
Children for whom DCFS has court-ordered legal responsibility who are placed in licensed or approved foster homes, institutions or group homes who no longer meet AFDC requirements but have been determined Medicaid eligible. |
Category 98 (Group 211/02) IV-E Foster Care/Voluntary |
Children for whom DCFS has legal responsibility via voluntary placement agreement who are placed in licensed or approved foster homes, institutions or group homes and who meet AFDC requirements. |
Category 98 (Group 211/12) MANG Foster Care/Voluntary |
Children for whom DCFS has legal responsibility via voluntary placement agreement who are placed in licensed or approved foster homes, institutions or group homes who no longer meet AFDC require-ments but have been determined Medicaid eligible. |
Category 98 (Group 211/05) IV-E Adoption Assistance |
Children who have been adopted with adoption assistance and who were AFDC-FC or SSI eligible at the time the adoption proceedings were initiated and who were AFDC, AFDC-FC, or SSI eligible during the month court proceed- ings leading to removal of the child from the home was initiated. |
Category 98 (Group 211/13) MANG/Non-AFDC |
Children for whom DCFS has legal responsibility via court order, voluntary placement agreement or adoptive surrender who are placed in licensed or approved foster homes, institutions or group homes who have never met AFDC requirements but have been determined Medicaid eligible. |
Category 98 (Group 211/15) Adoption Assis- tance/Medical Only |
Children who have been adopted with adoption assistance who are placed in adoptive homes who have never met AFDC requirements but have been determined Medicaid eligible. |
Category 98 (Group 211/30) MANG only /DOC |
Children for whom DCFS or DOC has court-ordered legal responsibility who have been placed in a DOC setting who are not AFDC eligible but have been determined Medicaid eligible. |
Category 98 (Group 313/12) Non-AFDC/MANG |
Children for whom DCFS has legal responsibility who are placed in any eligible living arrangement who have been determined AFDC and Medicaid ineligible but for whom DCFS has chosen to provide continued medical coverage and DCFS scholarship youth over age 21 for whom DCFS has chosen to provide continued medical coverage. |
Category 21 AFDC/MANG Ineligible |
Children for whom DCFS has accepted legal responsibility via court order, voluntary placement agreement or adoptive surrender who have been determined as ineligible for both AFDC-FC and MANG and will not receive a Medicaid card. Includes children who have been returned to home of parents. |
When a child has been issued a Temporary Medical Eligibility Card (DPA 469D), a data inquiry into CYCIS shall be completed to determine whether the child already has an open/active case. If the case is found active in CYCIS, the case information shall be provided when the call is made to the Eligibility Unit (800 228-6533).
When a child is placed from an active AFDC home (Category 04 and 06) or an active Medical Assistance home (Category 94 or 96) the worker/Regional Business Office shall attempt to secure the DPA case number and child's recipient number for billing purposes. When available, these numbers should be provided to the Eligibility Unit (800 228-6533) at the time of call-in.
The DPA 469D shall be authorized for a period not to exceed fourteen (14) calendar days from the date of issuance. Presentation of the regular green card or the Temporary card (DPA 469D) provides authorization to a medical provider for billing purposes. Charges for Medicaid eligible services provided by a Medicaid enrolled provider must be completed on appropriate DPA billing forms and submitted to DPA's Claims Processing Unit, 931 East Washington, Springfield, Illinois 62763. When services (Medicaid eligible and ineligible) are provided by a non-Medicaid enrolled provider (dental, optical and out-of-state) the billing statements must be submitted to the appropriate Regional Medical Liaison. (Refer to Procedures 359.9 G & H for detailed information regarding medical payments.)
Category 98. When the DCFS Eligibility Unit has determined, based on issuance of a DPA 469D and/or review of the data entered from the CFS 1411 (parent and child's income) and 1412 that a child is either AFDC-FC or MANG eligible, the child's caretaker will receive form DPA 469, Medical Eligibility Card ("MEC"). The Department of Public Aid will be notified of eligibility via form CFS 1860, Notice Regarding Assistance for Child Placed in Foster Care.
Category 21. When a child is determined to be ineligible for DPA Category 98 medical assistance because he/she has been returned to the home of parent, but the Department maintains legal responsibility, the Regional Business Office may select to cover certain medical costs for such children. The medical provider must submit the appropriate billing statements to the Regional Office where they are audited for accuracy and priced (DPA's allowable rate for medicaid eligible services or usual and customary for medical ineligible services.) Those priced are then vouchered and submitted to the DCFS Office of Financial Management for payment processing. When certain services cannot be priced at the Regional level, the Medical Liaison may contact the DPA Pricing Unit at 217 782-0484 for pricing. The Regional Office then vouchers the statements and submits them to the DCFS Office of Financial Management for payment processing.
o Non-ward unmarried mothers accepted under the Department's Unmarried Mothers Program
o Youth for whom DCFS has court ordered legal responsibility who are returned to, or in the home of parents and payment is not being made to a caretaker. NOTE: DPA shall be notified by the youth's worker of the planning when a youth is being returned to an active AFDC family to enable inclusion of the youth in the AFDC grant and/or to enable continued medical coverage by DPA. When a youth is returned to a
family not receiving AFDC but having insufficient resources to meet the child's medical needs, the family should be advised to apply to DPA for medical coverage for the child.
o Youth in a tuberculosis sanitarium, or DMH/DD non-medicaid-certified facility or unit.
Temporary Protective Custody Placements. The DPA 469D shall be issued for children taken into temporary protective custody when there is a medical need or placement anticipated. When children are placed from active AFDC homes with an available medical card, the regular green card shall be used.
DMH/DD Medicaid and Medicare Certified Facilities. Youth for whom DCFS has legal responsibility who are placed in a DMH/DD certified facility are eligible for category 98 medical assistance. Regardless to the timeframe of the youth's stay in the DMH/DD facility, the youth remains eligible for Category 98 medical assistance until age nineteen (19) and/or until the child becomes ineligible because of another factor (e.g., income) unrelated to the child's stay.
When a youth who is in a Medicaid/Medicare facility reaches age 18½ and his/her stay in the facility is expected to continue beyond another six (6) month period, the youth's DCFS worker is responsible for applying for MANG - Blind (Category 92) or MANG - Disability (Category 93) for the youth at the Public Aid Office serving the county in which the facility is located (in Cook County all applications are filed at the Nursing Home Services District Office). DCFS staff are to take the following steps to apply for MANG(D) or MANG(B):
o obtain the signature of the child's parent, guardian or custodian on Form DMH/DD l46, Authorization for Release of Information, when the Department's legal relationship with the child is by means other than court-ordered guardianship. When the Department has guardianship, the authorized agent shall sign form DMH/DD l46 in the following manner: (name of) Guardianship Administrator by (authorized agent's name). Form DMH/DD l46 enables DPA staff to have access to medical and financial records at the facility necessary to determine eligibility for MANG(D) or MANG(B).
o take completed DMH/DD l46, information concerning the child's income/ assets, parental information, birth verification to the DPA local office serving the county in which the facility is located and complete DPA 560, Request for Public Aid for Aged, Blind or Disabled.
o the DPA local office will determine eligibility for MANG(D) or MANG(B) and authorize the child for MANG, if eligible. DCFS will make payment only for non-DPA medically eligible youth (Category 2l) who are in certified facilities. See Procedures 359.9, Payments for Medical Care, for instructions regarding payment for medical expenses of category 21 youth.
POLICY GUIDES