04/18/2024
Summary
- Health Benefits for Immigrant Adults (HBIA) is for individuals ages 42 through 64. Income eligibility is determined by using Modified Adjusted Gross Income (MAGI) budgeting.
- Note: New enrollment in the Health Benefits for Immigrant Adults (HBIA) program was paused effective July 1, 2023.
- Health Benefits for Immigrant Seniors (HBIS) is for individuals ages 65 and older. This program follows the current AABD community eligibility criteria.
- Note: New enrollment in the Health Benefits for Immigrant Seniors (HBIS) program was paused effective November 6, 2023, at 5 p.m.
- HBIA/HBIS covers noncitizen adults and seniors, ages 42 and older, otherwise ineligible for any other medical benefits.
- Medical backdating of 3 months prior to the month of application is available.
- HBIA/HBIS medical benefits are state funded.
- Effective May 1, 2024, Lawful Permanent Residents are not eligible for Health Benefits for Immigrant Adults/Seniors.
- Health Benefits for Immigrant Adults/Seniors (HBIA/HBIS)
- Eligibility
- Health Benefits for Immigrant Adults (HBIA)
- Individuals eligible for HBIA
- Individuals not eligible for HBIA
- Health Benefits for Immigrant Seniors (HBIS)
- Individuals eligible for HBIS
- Individuals not eligible for HBIS
- Application Process
- Health Benefits for Immigrant Adults (HBIA)
- Health Benefits for Immigrant Seniors (HBIS)
- Emergency Medical for Noncitizens
- Health Benefits for Immigrant Adults (HBIA)
- Case Change/Redetermination Process
- Health Benefits for Immigrant Adults (HBIA)
- Health Benefits for Immigrant Seniors (HBIS)
- Benefit Coverage
- Covered Services: Examples of Covered Services
- Excluded Services
- Co-payments and Cost Sharing
- Integrated Eligibility System (IES)/MANG P
- Health Benefits for Immigrant Adults (HBIA)
- Health Benefits for Immigrant Seniors (HBIS)
- Manual Revisions
Health Benefits for Immigrant Adults/Seniors (HBIA/HBIS)
Effective 12/01/2020, pursuant to 305 ILCS 5/12-4.35(a-5), Illinois Department of Healthcare and Family Services (HFS) made medical benefits like those offered under Aid to the Aged, Blind or Disabled (AABD) available to noncitizens aged 65 and over who do not meet immigration status for Medicaid. This entirely state-funded special program is called Health Benefits for Immigrant Seniors (HBIS). New enrollment for the HBIS program was suspended for applications dated after November 6, 2023, at 5 p.m. due to having met an enrollment cap.
As of 5/1/2022, Illinois Department of Healthcare and Family Services (HFS) expanded coverage available to noncitizen adults with the enactment of Health Benefits for Immigrant Adults (HBIA) available to noncitizens ages 55 through 64 years old who are not otherwise eligible for medical coverage in the state of Illinois.
On 07/01/2022, pursuant to 305 ILCS 5/12-4.35(a-7), Health Benefits for Immigrant Adults was expanded to begin at age 42 for those who are not otherwise eligible for medical coverage in the state of Illinois. This expansion allows for Health Benefits for Immigrant Adults (HBIA) to cover ages 42 through 64. New enrollment for the HBIA program is suspended for applications dated 7/1/2023 and later pursuant to a June 16, 2023, public notice, Health Benefits for Immigrant Adults (HBIA) and Health Benefits for Immigrant Seniors (HBIS) Emergency Rulemaking and HBIA Temporary Enrollment Pause.
Eligibility
Health Benefits for Immigrant Adults (HBIA)
This program follows MAGI eligibility budgeting. An individual may be eligible for this program provided all the following criteria are met:
- Applicant is not a U.S. citizen;
- Applicant has a noncitizen status that does not meet the criteria for Medicaid. (See PM 03-01-00: Citizen/USCIS (U.S. Citizenship and Immigration Services) Status);
- Applicant is a resident of Illinois;
- Applicant is between the ages of 42 through 64 years old. Self-attestation is acceptable if the customer’s age cannot be verified electronically; and
- Applicant’s income is at or below 138% FPL. (See PM 08-03-00: MAGI Budgeting for more details on MAGI Budgeting).
- An inmate of a public institution may be eligible consistent with MAGI rules.
Individuals eligible for HBIA
Individuals not eligible for HBIA
- Applicant is eligible for Medicaid.
- Effective May 1, 2024, applicants who are Lawful Permanent Residents (LPR/green card holder).
- Note: Lawful Permanent Residents meeting the 5-year waiting period may be eligible for Medicaid. Lawful Permanent Residents under 5 years may be eligible for federally funded Marketplace coverage.
Health Benefits for Immigrant Seniors (HBIS)
This program follows the current AABD community eligibility criteria. An individual may be eligible for this program provided all the following criteria are met. (See PM 08-02-00: Aid to the Aged, Blind and Disabled for more details on AABD Budgeting):
Individuals eligible for HBIS
Individuals not eligible for HBIS
- An inmate of a public institution consistent with AABD rules.
- Applicant is eligible for Medicaid.
- Effective May 1, 2024, applicants who are Lawful Permanent Residents (LPR/green card holder).
- Note: Lawful Permanent Residents over 5 years may be eligible for Medicaid. Lawful Permanent Residents under 5 years may be eligible for Federally Facilitated Marketplace coverage.
Application Process
Applicants must be residents of Illinois and determined not to be eligible for other available medical benefits due to not meeting the citizen/immigration criteria as denoted in PM 03-01-00: Citizen/USCIS (U.S. Citizenship and Immigration Services) Status.
- Note: When an applicant with a SSN and/or an Alien Registration Number entered on the Non-Citizen Details screen is denoted as “Undocumented,” IES will display a message alerting the worker that denoting the individual as undocumented is inconsistent with the applicant having an SSN and/or an Alien Registration Number.
Health Benefits for Immigrant Adults (HBIA)
- Note: New enrollment in the Health Benefits for Immigrant Adults (HBIA) program was paused effective July 1, 2023, and remains paused at this time.
HBIA cases are processed similarly to ACA and Family Health Plan Cases. An applicant’s eligibility for one of the federally funded Medical Programs must be reviewed as part of their eligibility determination.
Individuals may obtain backdated medical coverage for up to three months prior to the month of application unless the individual does not meet all eligibility requirements for one or more backdated months.
Health Benefits for Immigrant Seniors (HBIS)
- Note: New enrollment in the Health Benefits for Immigrant Seniors (HBIS) program was paused effective close of business November 6, 2023, and remains paused at this time.
HBIS cases are processed similarly to AABD cases. An applicant’s eligibility for one of the federally funded medical programs must be reviewed as part of their eligibility determination.
Individuals may obtain backdated medical coverage for up to three months prior to the month of application unless the individual does not meet all eligibility requirements for one or more backdated months.
Emergency Medical for Noncitizens
A noncitizen determined eligible for either HBIA or HBIS may also qualify for emergency medical if the individual needs or has received emergency medical services during the month of application or during the 3 months prior to the month of application. Both medical programs can be on the same case.
When completing an application in ABE (Application for Benefits Eligibility), the applicant must answer the question, “Is this person a U.S. citizen?” If answered “No”, ABE will ask, “Is this a request for emergency medical for a noncitizen.” If “Yes”, a request for emergency medical for a noncitizen will be processed in IES.
To create an application for emergency medical the worker must navigate to the “Questions” page in the Individual Information section and select “Yes” to the “Special Medicaid Approvals” question.
Detailed policies and procedures should be reviewed at: MR #18.05: Emergency Medical Coverage for Noncitizens Not Meeting Immigration Status and PM/WAG 06-05-00 Emergency Medical for Noncitizens Who Do Not Meet the Federal Qualifying Medicaid Criteria.
Case Change/Redetermination Process
Eligibility will be redetermined annually and whenever a change is reported.
Noncitizens determined eligible for State funded medical, must have their status reviewed at each redetermination for possible change in their immigration status.
Customers reporting a change in immigration status or turning 65 years old should be considered for the appropriate program.
- Example: Mr. Heinz has HBIA but is turning 65 this month. His eligibility to transition to HBIS should be reviewed at redetermination.
When an update or redetermination is completed, cases must be reviewed to ensure customers are being placed in the correct program(s) and to check if the customer is eligible for one of the federally funded medical programs.
Health Benefits for Immigrant Adults (HBIA)
HBIA cases are maintained and renewed the same as ACA and Family Health Plan cases. Refer to PM 19-02-02 for processing ACA/Family Health Plan redeterminations.
- Example:
Elena, 45 years old, came to the U.S. in 1/1/xx on a H1B visa as a temporary employee of an IT firm in NY. Elena is eligible for HBIA.
However, she was forced to work in a sweatshop. After 2 years, Elena received assistance from local legal and volunteer agencies and Elena was granted a Victim of Trafficking status and received a Certification Letter from the Office of Refugee Resettlement (ORR). The “certification date” on the letter was 6/15/xx.
6/15/xx is the date Elena became a qualified alien and met immigration status requirements for federally funded assistance, therefore Elena should be reviewed to transition from HBIA to Medicaid.
Health Benefits for Immigrant Seniors (HBIS)
HBIS cases are maintained and renewed the same as AABD cases. Refer to PM 19-02-03 for additional details on processing AABD redeterminations.
- Example:
Maggie came to the U.S. in 1/1/xx as a student at the age of 66 years old. She stayed in the U.S. after her visa expired. Under her student visa and after it expired Maggie was eligible for HBIS.
Maggie applied for asylum with USCIS on 3/1/xx, therefore Maggie is now eligible for AATV or VTTC. Maggie should be reviewed to transition from HBIS to AATV or VTTC. Several years later Maggie received a USCIS decision granting her asylum. The USCIS letter stated her asylum approval date was 8/26/xx.
8/26/xx is the date Maggie became a qualified alien and met immigration status eligibility requirement for federally funded assistance, therefore Maggie should be reviewed to transition from AATV or VTTC to Medicaid.
Benefit Coverage
The health benefit programs provide comprehensive healthcare coverage with co-payments and cost sharing for certain services.
Covered health care services shall be the same as covered services for adults as described in AABD and MAGI programs except the excluded services listed below.
Covered Services: Examples of Covered Services
- Doctor, hospital care, lab tests
- Rehabilitative services such as physical and occupational therapy
- Mental health includes psychiatry, psychology, or services provided by a community mental health center
- Substance use disorder services
- Some dental services
- Eye care services
- Prescription drugs
Excluded Services
- Long-term care services
- Funeral and burial expenses
- Home and community-based waiver services
- Other services not covered under AABD as listed in PM 20-03-04-c: Services Not Covered
Co-payments and Cost Sharing
- Inpatient hospitalizations: $250 co-pay
- Hospital or Ambulatory Surgical Treatment Center outpatient services: 10% of the Department rate
Integrated Eligibility System (IES)/MANG P
An indicator and MANG P code was created to identify individuals approved under the HBIA and HBIS programs. Individuals approved under HBIA and HBIS can be identified by an indicator and specific MANG P code.
Health Benefits for Immigrant Adults (HBIA)
In IES a special indicator “(A)” was added to the existing ACA Adult and Family Health Plan Types of Assistance (TOA) within eligibility summary to identify the individual as HBIA.
The program is also denoted with a “Yes” next to “State Non-Citizen Program” in the EDG Information section of the selected EDG summary.
In MMIS the MANG P code is NI:
Health Benefits for Immigrant Seniors (HBIS)
In IES a special indicator “(A)” was added to the existing AABD Type of Assistance (TOA) within eligibility summary to identify the individual as HBIS.
The program is also denoted with a “Yes” next to “State Non-Citizen Program” in the EDG Information section of the selected EDG summary.
In MMIS the MANG P codes is 6I:
Manual Revisions
[signed copy on file]
Dulce M. Quintero
Secretary-Designate, Illinois Department of Human Services
Elizabeth M. Whitehorn
Director, Illinois Department of Healthcare and Family Services
