Section 125.240  Eligibility Determination and Enrollment Process

a)         If the monthly countable income is at or below 133 percent of the Federal Poverty Level for the number of individuals in the family, the individual will be enrolled in Medical Assistance, if otherwise determined eligible pursuant to 89 Ill. Adm. Code 120, Subpart H.

b)         If the monthly countable income is above 133 percent and at or below 200 percent of the Federal Poverty Level for a child, or at or below 185 percent of the Federal Poverty Level for an adult, for the number of individuals in the family, and all other eligibility requirements of this Part are met and enrollment is open, the individual will be enrolled in the Program.

c)         For purposes of cost sharing, families in the KidCare/FamilyCare Health Plan will be enrolled into either KidCare/FamilyCare Share or KidCare/FamilyCare Premium as follows:

1)         If monthly countable income is above 133 percent and at or below 150 percent of the Federal Poverty Level for the number of individuals in the family, the individual will be enrolled in KidCare/FamilyCare Share.

2)         If monthly countable income is above 150 percent and at or below 200 percent of the Federal Poverty Level for the number of individuals in the family, a child will be enrolled in KidCare Premium or, if monthly countable income is above 150 percent and at or below 185 percent of the Federal Poverty Level for the number of individuals in the family, an eligible adult will be enrolled in FamilyCare Premium.

d)         Applicants will be notified, in writing, regarding the outcome of their eligibility determination.

e)         Eligibility determinations for the Program made by the fifteenth day of the month will be effective the first day of the following month.  Eligibility determinations for the Program made after the fifteenth day of the month will be effective no later than the first day of the second month following that determination.  The duration of eligibility for the Program for children will be 12 months unless one of the events described in Section 125.205(c)(1) or (c)(3) occurs.  The 12 months of eligibility will commence when the first child in a family is covered under the Program.  Children added to the Program after the eligibility period begins will be eligible for the balance of the 12-month eligibility period.

f)          Individuals determined to be eligible for the KidCare/FamilyCare Health Plan may obtain coverage for a period prior to the date of application for the Program. This coverage shall be subject to the following:

1)         The family must request the prior coverage for the individual within six months following the initial date of coverage under the KidCare/FamilyCare Health Plan.

2)         The prior coverage will be individual specific and will only be available the first time the individual is enrolled in the Program.

3)         The prior coverage will begin with services rendered during the two weeks prior to the date the individual's application for the KidCare/FamilyCare Health Plan was filed and will continue until the individual's coverage under the KidCare/FamilyCare Health Plan is effective pursuant to subsection (e).

(Source:  Amended at 30 Ill. Reg. 10328, effective May 26, 2006)