Section 125.225  Presumptive Eligibility for Children

a)         A child younger than 19 years of age may be presumed eligible for an All Kids Health Plan under this Part if all of the following apply:

1)         an application for medical benefits has been made on behalf of the child;

2)         the child is a resident of Illinois;

3)         the child is not an inmate of a public institution as described in Section 125.205(a)(1);

4)         effective October 1, 2013, the child is a member of a family whose monthly countable income, as stated on the application, is above 133% of FPL and at or below 200% of FPL as determined using the MAGI methodology;

5)         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 89 Ill. Adm. Code 125.200(e) or 89 Ill. Adm. Code 118.500; and

6)         the child has not been presumed eligible under this Part 125 or 89 Ill. Adm. Code 118 or 120 within the past 12 months.

b)         Entities qualified to make a determination of presumptive eligibility include State employees involved in enrolling children in programs under this Part 125 or 89 Ill. Adm. Code 118 or 120.

c)          The presumptive eligibility period begins on the date of application.

d)         The presumptive eligibility period ends on the date the State's determination of the child's eligibility under this Part 125 or 89 Ill. Adm. Code 118 or 120 is updated in the data system.

e)          No copayment or premium requirements apply during the period of presumptive eligibility.

(Source:  Amended at 38 Ill. Reg. 18451, effective August 19, 2014)