Agent Alert #1

Health Insurance for Illinois Families
KidCare Application Agent Alert #1
Addendum to the 09/04 KCAA Manual 07/05

New Information

FamilyCare Increase for Parents and Other Caretakers - Governor Blagojevich's budget initiative to increase the FamilyCare income standard to 185% of poverty passed the General Assembly. This increase will go into effect January 1, 2006.

This means that parents with income greater than 133% and equal to or less than 185% FPL may be eligible for Share, Premium and Rebate.

A "Client Notice" will be mailed this fall to announce the increase and invite potentially eligible parents to request coverage.

We will give KidCare Application Agents (KCAAs) an update later when more details are available.

As of July 1, 2005, the Department of Public Aid’s name has officially changed to Healthcare and Family Services (HFS). Our new name is more consistent with the agency’s mission - to serve Illinois families with their health care, home energy, and child support needs. The department’s relationship to KCAAs remains the same.

You will see the new name on forms, letters and the Internet. Until existing form supplies are exhausted, however, we will continue to use materials bearing the former DPA name and logo. Either version of the documents should be considered official regardless of the department name they bear.

Web-Application

Beginning May 19, 2005, Champaign Urbana Public Health Department (CUPHD) began submitting KidCare/FamilyCare applications electronically through a Web-based application.

The online application is an electronic version of the KC 2378MC KidCare/FamilyCare application currently used by KCAAs. To access the Web-application KCAAs must be registered with the Medical Electronic Data Interchange (MEDI). Each staff member that will be using the Web-based application must obtain their own digital certificate and be authorized by their administrator to use the Web-based application in MEDI.

The online application will provide a simple and secure way for KCAAs to apply for health benefits for Illinois families through the Internet. Like KC 2378MC applications, KCAAs should not submit online applications until they are complete.

The online system will assign a unique Household ID number to each application. The KidCare Unit uses this number to match the electronically submitted application with the documents that are faxed in by the KCAA.

KCAAs will be able to stop the application process at any time and save what they have completed. They can return to a saved Web-application later, using the Household ID number, to enter more information and submit the application.

When a KCAA submits an application electronically, a Fax cover sheet and a Read and Sign page will print with the assigned Household ID number. The applicant must sign and date the Read and Sign page and the KCAA must write the household ID number on other documents being faxed. KCAAs have 24 hours to fax the cover sheet, the Read and Sign page and any required documentation to KidCare.

Please Note – KC 2378MC KidCare/FamilyCare applications currently used by KCAAs will continue to be available to be mailed to KidCare.

For more information and technical assistance, call:

Northern Illinois: 312-793-2925.
Downstate: 217-557-9315 or 217-557-8608.

I-SaveRx - Governor Blagojevich created I-SaveRx to give all Illinois residents, regardless of age, the opportunity to purchase 120 of the most common brand name prescription drugs from licensed and inspected pharmacies in Canada and the United Kingdom at an average savings of 25 – 50%.

This is a mail in order program for refills only. Here are some examples of families that may benefit from the I-SaveRx prescription drug program:
- Self-Employed individuals
- Undocumented Immigrants
- Low wage-workers
- Service industry workers
- Seniors over age 65
For more information or to order outreach materials phone 217-524-7156, Monday through Friday between 8 a.m. and 4:30 p.m.

Reminders

2005 Federal Poverty Levels (FPLs) – The KidCare Processing Unit is now using 2005 FPLs to determine eligibility for all KidCare and FamilyCare plans. Only KidCare and Department of Human Services Community Resource Center staff may determine eligibility.
KCAAs may now complete and electronically submit the DPA 1517KC; KCAA Provider Forms Request to order KidCare/FamilyCare forms.

All KidCare/FamilyCare forms have been relocated to one warehouse. The warehouse is located at 2946 Old Rochester Road, Springfield, IL 62703.

Northern Illinois and Downstate Illinois KCAAs ordering by mail or fax must use the attached DPA 1517KC, KCAA Provider Forms Request.

For a complete list of KidCare/FamilyCare forms available by fax, mail or electronically, refer to Page 68 of the 09/04 KCAA Manual.

E-Mail Notification of New Provider Releases. As part of our ongoing effort to keep KCAAs informed, the department has a new feature on its Web site that allows KCAAs to register to receive e-mail notification when new provider information has been posted to the Web site. KCAAs are encouraged to register to receive immediate access to the latest developments regarding KidCare.

Remittance Advice Error Codes for Technical Assistance Payments (TAP) – TAP denial error codes have recently changed from an alpha code to a numeric code. The table below provides the corresponding description for each alpha/numeric error code:

ALPHA CODE	ERROR CODE	DESCRIPTION
A	X80	The checklist was not attached or was not complete.
B	X81	The application was not signed or dated.
C	X82	All relevant questions were not answered.
D	X83	Pages 1, 2, or 3 were not included.
E	X84	Social Security numbers (SSN) or proof of application for a SSN were not attached.
G	X86	Alien registration numbers and immigration documentation are required but not provided.
H	X87	A pregnant woman applied and proof of pregnancy was not provided.
I	X88	Sufficient proof of income was not attached.
J	X89	The application is a Chicago Public School special mail-in application.
K	X93	Applicant signature on the application is greater than 30 days from the time is received in the KidCare Unit.
L	X94	Applicant’s signature date has been altered.
M	X95	Sufficient proofs of deductions were not included and without verifications the applicant is ineligible for all KidCare plans.
N	X42	The KCAA contact person completed his or her own application.
P	X43	Application was sent to the wrong office. (Realbenefit® KCAAs only).
Q	X44	Medical only requested using the 2378B (Realbenefit® KCAAs only).
Z	X90	More than 3 denial reasons.
X	X91	Application previously paid.

All KidCare/FamilyCare policy and technical assistance questions should be directed to HealthCare and Family Services KidCare/FamilyCare liaisons.

Northern Illinois:
Technical Assistance Questions 1-312-793-2925
Technical Assistance Fax 1-312-793-5278

Downstate:
Technical Assistance Questions 1-217-557-9315 or, 1-217-558-1532
Downstate Technical Assistance Fax: 1-217-557-5801

Now that Temporary KidCare (PE) coverage is being authorized for children, KCAAs should remember to inform families of their right to choose a medical provider. A family does not have to receive medical services at the site where they applied for KidCare/FamilyCare benefits.

To be considered for Medicaid Presumptive Eligibility (MPE) a woman has to be pregnant at the time the MPE application is signed. A woman who has given birth within the last three months may apply for Moms & Babies and request medical backdating on a 2378MC or 2378KC application. Medical backdating is not available for MPE.

MPE Providers: Citizenship does not affect eligibility for MPE. Citizen and non-citizen pregnant women are eligible to receive MPE coverage if they have a medically verified pregnancy, live in Illinois and their family income does not exceed the limit for their family size. Questions about MPE should be directed to Tracy Keen at 1-217-557-8636.

Pregnant Women and their SSNs - Pregnant women are not required to provide an SSN, but it may benefit them to do so. A woman who does not provide an SSN will lose eligibility after her two-month postpartum coverage has ended. If she provides an SSN she may be eligible to go on FamilyCare after the coverage based on her pregnancy has ended. If she is not eligible for FamilyCare, she may qualify to receive family planning and reproductive health services under Illinois Health Women.

KCAA TRAINING SCHEDULE

Downstate:
Galesburg…………………………………. August 10, 2005
Mt. Vernon………………………………... September 8, 2005

Trainings are scheduled each month throughout the downstate area. For more information or if you are unable to attend any of the training sessions you may call 217-557-9315 to arrange training at your site.

Northern Illinois:
Chicago…………………………………. July 22, 2005 (English – Afternoon)
Chicago…………………………………. August 5, 2005 (English – Morning)
Chicago…………………………………. August 19, 2005 (English – Morning)
Chicago…………………………………. August 12, 2005 (Spanish – Morning)
Chicago…………………………………. September 9, 2005 (English – Morning)
Chicago…………………………………. September 23, 2005 (English – Afternoon)

Corrections

On Page 43, of the 09/04 KCAA Manual, in the "Note" statement under Number 10, "Women who were pregnant during any of the three months prior to application, should mark "yes" and write in the date that the pregnancy ended. A statement from a doctor or clinic is still required” should be changed to:

"Women who were pregnant during any of the 3 months prior to application, should mark "yes" and write in the date that the pregnancy ended. A signed statement from a doctor or clinic must be included confirming the end of a pregnancy unless the woman who gave birth is also applying for the newborn child. The newborn's date of birth is sufficient proof that a pregnancy occurred."

On Page 52, of the 09/04 KCAA Manual, a letter from the employer, which includes:

Name of employee
SSN (optional)
Number of hours per week
Payment frequency – weekly, bi-weekly, twice monthly
Rate of pay
Signature of person writing the letter, their title or position and phone number
*The person writing the letter must also date the letter

Approval Rate

The approval rate for applications submitted by KCAAs is 91 percent. Of the 91 percent, TAP is issued on 86 percent of these applications. Congratulations on your success in helping families enroll in KidCare and FamilyCare!