Section 1200.80 Financial Assistance Eligibility and Standards

Section 1200.80

Financial Assistance Eligibility and Standards

a)         DSCC may pay a provider or

other eligible persons for covered supports and services rendered to an applicant

or recipient child. The LRA may qualify for financial assistance when the

criteria of this subsection (a) are met.

1)         The applicant or recipient

child:

A)        Is under 21 years of age;

B)        Meets or is suspected of

meeting the medical eligibility criteria in Section 1200.110;

C)        Is a resident of Illinois

as set forth in Section 1200.100; and

D)        Is a U.S. citizen or

lawfully admitted to the United States.

If neither of these requirements are met, the LRA must

be a U.S. citizen or lawfully admitted to the United States.

2)         If the applicant or recipient

child is not the LRA, the LRA must be a resident of Illinois as set forth in

Section 1200.100.

3)         The applicant or recipient child:

A)        Is eligible for a medical

assistance program under the Illinois Public Aid Code [305 ILCS 5], the

Covering All Kids Health Insurance Act (All Kids) [215 ILCS 170], or the

Children's Health Insurance Program Act (CHIP) [215 ILCS 106];

B)        Meets the financial

requirements of Medicaid, All Kids or CHIP but is not eligible for coverage

based on the nonfinancial criteria; or

C)        The LRA has a household

income at or below 325% federal poverty level (FPL) as outlined in https://aspe.hhs.gov/poverty-guidelines.

b)         Diagnostic services may be

provided without regard to the financial eligibility criteria of subsection (a)(3)

in accordance with Section 1200.90 and only when the criteria of subsections (a)(1)(A),

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based on the nonfinancial criteria; or

C)        The LRA has a household

income at or below 325% federal poverty level (FPL) as outlined in https://aspe.hhs.gov/poverty-guidelines.

b)         Diagnostic services may be

provided without regard to the financial eligibility criteria of subsection (a)(3)

in accordance with Section 1200.90 and only when the criteria of subsections (a)(1)(A),

(a)(1)(C), (a)(1)(D) and (a)(2) are met.

c)         When more than one child

in a family qualifies for financial assistance, DSCC may give each eligible

child the same period of eligibility.

d)         DSCC shall only provide financial

assistance for covered supports and services as set forth in Section 1200.120.

e)         Payment shall only be made

on behalf of applicant or recipient children to providers or other eligible

persons who meet the requirements of this Part.

f)         Eligibility for financial assistance

shall be redetermined annually and whenever a change occurs that impacts the

eligibility criteria of subsections (a)(1) and (a)(2). Changes to subsection (a)(3)

shall not be a cause to initiate a redetermination outside the annual

redetermination process.

g)         Except as provided in

Section 1200.170, eligibility for financial assistance shall end:

A)        When the requirements of

subsections (a)(1) and (a)(2) are no longer met; or

B)        When the requirements of

subsection (a)(3) are not met as part of the annual redetermination process.