The Illinois Medicaid Redetermination form is a crucial document that individuals must complete to renew their medical coverage under the state's Medicaid program. This form, also referred to as "redetermination," requires applicants to provide updated information about their household, income, and any changes in health insurance. To ensure continued benefits, it is essential to fill out the form accurately and submit it by the specified due date.
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Renewing your medical coverage in Illinois is an important task that requires attention to detail. The Illinois Medicaid Redetermination form is your key to maintaining your benefits. When you receive this form, it will include your personal information, such as your name, address, and case ID, along with a notification that it's time for renewal, often referred to as "redetermination." To successfully complete the process, you must answer all questions accurately, sign the form, and provide necessary documentation like proof of income and expenses. Be mindful of the due date for submission, as failing to send in your completed form and supporting documents on time could result in the loss of your medical benefits. You can submit your form via fax, mail, or email, depending on what works best for you. If you have any questions or need assistance, there are resources available to help you navigate this process. Make sure to keep your information organized and respond promptly to ensure your coverage continues without interruption.
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Understanding the Illinois Medicaid Redetermination form is crucial for maintaining medical coverage. However, several misconceptions can lead to confusion. Below is a list of common misunderstandings regarding this form.
In reality, completing the redetermination form is mandatory to continue receiving Medicaid benefits. Failure to submit the form may result in the termination of coverage.
Supporting documents, such as proof of income and expenses, must accompany the redetermination form. Incomplete submissions may delay processing or lead to denial of benefits.
There is a specific due date for submitting the redetermination form. Late submissions can jeopardize medical coverage.
All adult members living in the household must provide information and sign the form if applicable. This ensures that all relevant data is accurately reported.
Any changes in income or household composition must be reported on the redetermination form. This information is essential for determining eligibility and benefits.
The requirements and processes for redetermination can change. It is important to review the instructions carefully each year to ensure compliance with current guidelines.
Assistance is available for completing the redetermination form. Individuals can call the provided helpline for guidance and support.
Faxing is an accepted method for submitting the redetermination form and supporting documents. Ensure that the correct fax number is used for submission.
Individuals may not receive prior notification if they fail to submit the redetermination form on time. It is essential to adhere to deadlines to avoid any lapse in coverage.
State of Illinois
Department of Healthcare and Family Services
Department of Human Services
ILLINOIS MEDICAID REDETERMINATION
<Name>
<Address><Barcode> <City, State ZIP>
<Letter Date>
Case ID: <Case ID>
Dear <Name>,
It is time to renew your medical coverage!
It’s time for renewal, also known as “redetermination” or “re-de.”
<Special Message Text>
Here’s what to do
1.Answer all questions on this form.
2.Sign this form at the bottom of page <3>.
3.Attach all proofs of income and expenses and other proofs we ask for.
4.Send your signed form and all proofs by <Due Date>.
Send your form and proofs to us one of these ways:
¨Fax your form and proofs to 1-855-394-8066
¨Mail your form and proofs in the envelope that we sent you
¨E-mail your form and proofs to HFS.medredes@illinois.gov
Your medical benefits may end if you do not send your proofs by <Due Date>.
Call us at 1-855-458-4945 (TTY: 1-855-694-5458) if you cannot send everything on time or if you have questions. We may be able to help you get the proofs you need.
Thank you,
Illinois Medicaid Redetermination
Questions? Call 1-855-458-4945 (TTY: 1-855-694-5458). The call is free!
Monday to Friday from 7 a.m. to 9 p.m. and Saturday from 8 a.m. to 1 p.m.
E-mail us at HFS.medredes@illinois.gov or send a fax to 1-855-394-8066.
Tenemos información en español. ¡Servicio de intérpretes gratis!
[MODE1]12/13 - [LT] - [LN] - [PM] - [NC]
Llame al 1-855-458-4945.[FILENAME] - [LETTERID]
[MAILINGNAME] - [BIFILEID]
Department of Healthcare and Family Services<Barcode>
Medical Renewal Form
1.Do these people still live with you?
<MemberName>
<MemberDOB>
Yes
No
2.Tell us about anyone else who lives with you:
Name
Date of birth
Relationship to you
First, Middle, Last, Suffix (Jr., Sr., II or III)
(month/day/year)
(for example: spouse, child, parent)
Name:
Date of birth:
Relationship:
3.Is anyone who lives with you pregnant?
If yes, name: ______________________________________________________ Due date: ____________________________ Expected number of babies: __________
4. Did you or anyone living with you get new health insurance in the last year? Yes No
If yes, name of insurance plan:__________________________________________________________
Who is covered by this health insurance? ___________________________________________________________________________________________________________________
5.Will you or anyone who lives with you file a federal income tax return next year to report
income earned this year? Yes No
If yes, name of person filing tax return: ______________________________________________________________________________________________________________________
If this person will file jointly with a spouse, write name of spouse: ________________________________________________________________________
If this person will claim dependents on the tax return, write name(s) of dependents:
________________________________________________________________________________________ ________________________________________________________________________________________
Page 1
[MODE1]
12/13 - [LT] - [LN] - [PM] - [NC]
Llame al 1-855-458-4945.
[FILENAME] - [LETTERID]
6. Can you be claimed as a dependent on anyone’s tax return?
Yes No
If yes, name of person: _____________________________________________________________________
Relationship to you:______________________________________
7.Do you and everyone living with you still get this income from these sources?
Salary, wages, and tips for everyone
Total per month: $ <amount>
(total before taxes are taken out)
Is this correct?
Self-employment income for everyone
(profit once business expenses are paid)
Unemployment for everyone
Social Security for everyone
Pension or retirement income for everyone
Spousal support received by everyone
Interest or investment income for everyone
Rental fees or royalties for everyone
¨¨If you checked no for any income, write the correct amount in the next section.
8.Do you or anyone living with you get other income? Check all that apply.
Salary, wages, and tips
How much?
How often?
Self-employment
Unemployment
Social Security
Pension or retirement income
Interest or investment income
Rental fees or royalties
Spousal support received
Other: ________________________________________________
¨¨Attach proof of the amount for any income received in the last 30 days.
Page 2
9.Do you or anyone living with you pay any of these expenses? Check all that apply.
Spousal support paid to someone else
Student loan interest paid
¨¨Attach proof of all expenses paid in the last 30 days.
10.We also need these proofs from you:
Copy of a Social Security card for <MemberName>
Other: _____________________________________________________________________________________________________________________________________________________________________
11.Read and sign below:
I understand that officials in charge of my health benefits may check all information on this form.
I understand they may check my information electronically. If they ask for my help checking information, I must cooperate.
I understand that anyone who knowingly lies or provides untrue information, or arranges for someone to knowingly lie or provide untrue information, or intentionally misuses the health benefits card issued by the State of Illinois, may be committing a crime which can be prosecuted or punished under federal law, state law, or both.
If the Illinois Department of Healthcare and Family Services pays medical bills for me, the State of Illinois may collect my medical support payments instead of me.
I am signing this form under the penalty of perjury. That means the information I have provided on this renewal form is true to the best of my knowledge, and I may be punished under law if I provide false or untrue information.
_______________________________________________
_________________________________
Your signature
Today’s date
12.Remember! Make sure you answered all questions and signed the form.
¨¨Send this form to us with all proofs by <Due Date>.
Page 3
When filling out the Illinois Medicaid Redetermination form, there are important steps to follow. Here’s a list of things you should and shouldn’t do:
Following these guidelines will help ensure a smooth renewal process for your medical coverage.
Completing the Illinois Medicaid Redetermination form is essential for maintaining your medical coverage. Follow these steps carefully to ensure that you provide all necessary information and documentation. Missing details could lead to delays or loss of benefits.
After you submit your form, the Illinois Medicaid office will review your information. They may contact you for further details if needed. It’s important to keep a copy of everything you send for your records. If you have questions during the process, don't hesitate to reach out to the provided contact numbers for assistance.