The Illinois Department of Human Services and Department of Healthcare and Family Services have announced a significant update regarding the Illinois Department on Aging (DoA) Community Care Program (CCP). Effective September 1, 2010, the costs associated with DoA/CCP services are now recognized as allowable medical expenses for individuals seeking to meet their medical spenddown requirements in Illinois. This policy change aims to streamline the process for eligible individuals to access both medical assistance and vital community care services.
This update means that for those applying for or currently receiving services through the Illinois Department On Aging Community Care Program, the expenses incurred can contribute towards meeting their spenddown. Spenddown is the process by which individuals with income exceeding the limit for Medicaid eligibility can become eligible by deducting incurred medical expenses from their income.
Key Changes and Implications
This policy initiative introduces several important changes that impact both individuals seeking assistance and the administrative processes involved:
DoA/CCP Service Costs as Medical Expenses
The most significant change is the recognition of Illinois Department on Aging Community Care Program service costs as legitimate medical expenses for spenddown purposes. This simplifies the process for individuals who require both in-home care services and medical assistance. Previously, navigating these systems separately could be complex.
Automated System for Spenddown Management
To facilitate this change, the Illinois computer system has been updated to automatically identify individuals whose Illinois Department on Aging Community Care Program service costs meet or exceed their spenddown amount. When this occurs, the system will automatically update the case status to “met,” ensuring timely access to medical benefits.
Retroactive Eligibility and Backdating
The system is also designed to retroactively grant eligibility for up to three months. This backdating applies if an individual was already receiving Illinois Department on Aging Community Care Program services during those months and the accumulated cost of these services is sufficient to meet their spenddown for that period. This feature provides crucial financial relief and ensures coverage for those who were already utilizing CCP services.
Enrollment in Pay-in Spenddown
Individuals receiving services through the Illinois Department on Aging Community Care Program now have the option to enroll in Pay-in Spenddown. This program allows individuals to pay the difference between their income and the Medicaid income limit to become eligible for Medicaid. The integration with DoA/CCP services provides another pathway to manage medical expenses and access needed care.
Application Process and Requirements
For individuals seeking to benefit from these changes, it’s important to understand the application requirements:
Mandatory Application for Medical Benefits
Anyone applying for Illinois Department on Aging Community Care Program services is now required to also apply for medical benefits. Care Coordination Units (CCUs) are responsible for assisting applicants in completing this medical benefit application process.
Coordination between CCUs and Family Community Resource Centers (FCRCs)
CCUs play a critical role in the application process. They will provide applicants with the necessary forms, including HFS 2378H (Mail In Application for Medical Benefits) and HFS 2538B (IDoA Notification), and forward these to the Family Community Resource Center (FCRC). This ensures that both the application for community care services and medical benefits are processed in a coordinated manner.
Verification of DoA/CCP Service Costs
In situations where the Illinois Department on Aging Community Care Program service costs are not automatically recognized by the system as sufficient to meet spenddown, the CCU will provide Form 2538B to the FCRC. This form verifies the costs of DoA/CCP services, allowing the FCRC to manually apply these expenses towards the individual’s spenddown requirement.
Practical Application of DoA/CCP Expenses for Spenddown
To ensure proper handling of these expenses, Family Community Resource Centers (FCRCs) are instructed on the following procedures:
Timing of Expense Consideration
When determining spenddown status, FCRCs should consider the estimated cost of Illinois Department on Aging Community Care Program services as incurred on the first day of the month, irrespective of when the services are actually delivered. These service costs should be prioritized and applied to the spenddown obligation before considering other medical bills.
No Time Limit for Expense Usage
There is no time limit on how long DoA/CCP service costs can be used to meet spenddown. If the costs for a given month are not sufficient to meet spenddown in that month, they can be carried over and applied to future months. However, any remaining amount from a month, after meeting spenddown, cannot be carried over.
Utilizing Expense Type ‘A’ in ASDS
When entering Illinois Department on Aging Community Care Program service costs into the Automated Support Desk System (ASDS), caseworkers are required to use expense Type ‘A’. This ensures proper categorization and processing of these specific medical expenses.
Central System for Meeting Spenddown
The automated system plays a central role in streamlining the spenddown process for individuals utilizing Illinois Department on Aging Community Care Program services:
Monthly System Matching
The computer system performs monthly checks to identify clients whose monthly DoA/CCP service costs equal or exceed their monthly spenddown amount. This matching process occurs at schedule 08 cut-off each month, ensuring regular and timely updates to case statuses.
System-Generated Notices and Reports
The system generates various reports and notices to manage and track spenddown status changes:
- Mobius Report #R8450469-03: Produced daily, this report identifies cases that have received either a Notice of Determination of Spenddown Met (Form 458SP-2) or a Notice of End of Eligibility for Medical Assistance (Form 3358A). These notices are automatically sent when cases transition between met and unmet status.
- Mobius Report #R83003741: Generated monthly, this report identifies cases that have been terminated or where the monthly service costs are no longer sufficient to meet spenddown through the central system.
System Actions Based on Spenddown Status
When Illinois Department on Aging Community Care Program services are sufficient to meet spenddown, the system automatically makes the following changes:
- Updates Item 80 code 390 met/unmet indicator to ‘4’.
- Deletes Item 80 code 396.
- Reduces the amount following Item 80 code 392 to zero, if necessary.
- Changes Item 20 code ’16’ to ’18’ (unless Item 20 is already coded ’20’).
- Generates TA 31/TAR A4.
- Sends Form 458SP-2 to the client.
Conversely, when DoA services are terminated or the costs are no longer sufficient to meet spenddown, the system takes these actions:
- Changes Item 80 code 390 met/unmet indicator to ‘2’.
- Sends Form 3358A to the customer.
- Changes Item 20 code ’18’ to ’16’.
- Generates TA 31/TAR A5.
Medical Backdating and Pay-in Spenddown
Backdating with DoA/CCP Service Costs
The policy allows for medical backdating up to three months prior to September 1, 2010, using Illinois Department on Aging Community Care Program service costs. If an individual was receiving DoA/CCP services and the monthly cost met or exceeded their spenddown amount during those months, the system will centrally backdate eligibility. FCRCs can also manually apply DoA/CCP service costs for backdating if it was not done centrally, using Form HFS 2538B for verification.
Pay-in Spenddown Option
Individuals receiving Illinois Department on Aging Community Care Program services can enroll in the Pay-in Spenddown program. Information and enrollment forms can be obtained by contacting the Healthcare and Family Services (HFS) Hotline.
Conclusion
This policy update regarding the Illinois Department on Aging Community Care Program and spenddown represents a significant improvement in the integration of healthcare and community support services in Illinois. By recognizing DoA/CCP service costs as allowable medical expenses and automating key processes, the state aims to simplify access to medical assistance for eligible individuals and ensure they receive the care and support they need. The changes detailed in this update are crucial for caseworkers, healthcare professionals, and individuals seeking to understand and utilize the Illinois Department on Aging Community Care Program effectively.
