Section 120.67  Presumptive Eligibility for Children

a)         The purpose of Presumptive Eligibility for Children (CPE) is to enable timely provision of preventive and treatment services to children.

b)         Children younger than 19 years of age, as defined in Section 5-2(6)(a) of the Public Aid Code may be presumed eligible for medical assistance under this Section if all of the following apply:

1)         an application  has been made on behalf of the child and received by the State;

2)         unless the federal Centers for Medicare and Medicaid Services directs the Department otherwise, the child is not living in a jail, prison, half-way house, or juvenile detention facility, including being on work release, furlough or admitted for inpatient hospital treatment from such facilities;

3)         the State employee who registers the application has no information that the child is not a U.S. citizen or a qualified non-citizen as described in Section 120.310 or 89 Ill. Adm. Code 118.500; and

4)         the child has not been determined presumptively eligible within the past 12 months under this Section, Section 120.68 or 89 Ill. Adm. Code 118 or 125 within the past 12 months.

c)         The CPE period under this Section begins on the date of application and ends on the date the State's determination of the child's eligibility under this Part or 89 Ill. Adm. Code 118 or 125 is updated in the data system.

d)         Services covered during the CPE period under this Section shall include all services covered for children under the Illinois State Medicaid Plan.

e)         Entities qualified to make a determination of CPE under this Section include State employees involved in enrolling children in programs under this Part or 89 Ill. Adm. Code 118 or 125.

(Source:  Added at 40 Ill. Reg. 2784, effective January 20, 2016)