Ill. Admin. Code tit. 89 § 120.11

Current through Register Vol. 48, No. 45, November 8, 2024

Section 120.11 - Eligibility for Pregnant Women and Children

a) Pregnant Women Eligible

1) Eligibility for medical assistance exists for a pregnant woman of any age who meets the following eligibility requirements:

A) cooperation in establishing eligibility as described in Section 120.308;

B) residency as described in Section 120.311; and

C) whose countable monthly income is at or below 200% of FPL as determined pursuant to Section 120.64.

2) Beginning on the last day of the pregnancy, the pregnant woman shall be eligible to receive medical assistance for 60 days. The 60 day medical assistance continues through the last day of the calendar month in which the 60 day period ends. The 60 day medical coverage period shall be provided for all women determined eligible for medical assistance under subsection (a)(1), including women who are no longer pregnant at the time of application, but were pregnant at any time during the three calendar months preceding the month in which the application was received. A woman who meets the requirements of this Section is eligible regardless of whether the pregnancy ended as a result of birth, miscarriage or abortion and regardless of whether she signed an adoption agreement.

3) When a pregnant woman is determined eligible for medical assistance under subsection (a)(1), income changes occurring after the eligibility determination are not considered through the 60 day postpartum period following the last day of pregnancy.

b) Children Under Age 19

1) Eligibility for medical assistance exists for children under age 19 who meet the following eligibility requirements:

A) cooperation in establishing eligibility as described in Section 120.308;

B) citizenship/alienage status as described in Section 120.310;

C) residency as described in Section 120.311; and

D) whose countable monthly income is at or below 313% of FPL as determined pursuant to Section 120.64.

2) Children under age 19 shall be eligible to receive medical assistance under subsection (b)(1) for a period of time as determined in Section 120.400.

3) When the Department becomes aware of the birth of a child or children to a woman determined eligible under subsection (a)(1) while she was eligible, the child or children shall be deemed to have applied and been found eligible for medical assistance under subsection (b)(1), without written request. The child or children shall be eligible to receive medical assistance for a period of time as determined in Section 120.400.

Ill. Admin. Code tit. 89, § 120.11

Amended at 38 Ill. Reg. 5967, effective February 26, 2014

Amended at 47 Ill. Reg. 16366, effective 11/3/2023