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), (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.