HFS Notice: Illinois Healthy Women Program (Family Planning Waiver) Updates

06/04/14

 

Informational Notice

 

To: Participating Physicians, Advanced Practice Nurses, Federally Qualified Health Centers, Rural Health Clinics, Encounter Rate Clinics, School Based Clinics, Local Health Departments, Pharmacies, Hospitals and Hospital Clinics

 

Re: Illinois Healthy Women Program (Family Planning Waiver) Updates

The purpose of this notice is to provide updates regarding the Illinois Healthy Women (IHW) program to family planning providers.

• IHW is scheduled to end December 31, 2014. Since April 2004, the IHW program has provided a limited package of family planning (birth control) and related reproductive healthcare benefits to low-income women in Illinois who were not otherwise eligible for other Illinois Department of Healthcare and Family Services (HFS) medical benefits programs. New federal health reform laws, also known as the Affordable Care Act, require all individuals to have minimum essential healthcare coverage, which includes birth control services. Therefore, women enrolled in IHW will now have the opportunity to obtain comprehensive healthcare coverage through either Expanded Medicaid or the Health Insurance Marketplace.

To ensure a seamless transition into affordable health care plans, HFS will continue to provide coverage under IHW through December 31, 2014 to allow a period for IHW clients to obtain other healthcare coverage and have continued access to their birth control method. Any service claims for IHW coverage with dates of service on or after January 1, 2015 will not be accepted. Providers are encouraged to verify eligibility prior to providing care and should refer to Informational Notice issued on January 30, 2013 (pdf) for guidance.

Additionally, HFS is sending bi-monthly notices to IHW clients as a reminder that the program is ending and to give instructions on how to apply for full benefits. Individuals without comprehensive healthcare coverage are instructed to go to the GetCoveredIllinois.gov website to explore their healthcare options and to apply for full benefits coverage through Expanded Medicaid or through the Health Insurance Marketplace (during open enrollment periods). Individuals may also call 1-866-311-1119 to speak to a representative. To ensure access to birth control services for women who miss the open enrollment period, HFS will continue to process applications for enrollment in IHW until September 30, 2014.

• As previously mentioned, HFS will continue to provide coverage under IHW through December 31, 2014 to allow a period for IHW clients to obtain other healthcare coverage. However, due to a programming error, some IHW clients were erroneously determined ineligible during the period of January 1 - April 30, 2014. Before denying any services to IHW clients, providers should double check current eligibility through the Medical Electronic Data Interchange (MEDI) system to make sure family planning services are not discontinued inappropriately.

Any questions regarding this notice may be directed to a medical assistance consultant in the Bureau of Professional and Ancillary Services at 1-877-782-5565.

Theresa A. Eagleson, Administrator
Division of Medical Programs